Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
Interesting question. Not being an endocrinologist, I don't have the expertise to advise but the reference below makes the statement that even short-term steroids can be an issue. I suspect that if you have to stop abruptly from 60 mg daily for 2 weeks, it would probably be fine in most instances bu...
What is your step-wise approach to treating worsening ocular myasthenia gravis symptoms?
I will assume that the patient is AChR antibody positive or seronegative (MuSK is a different discussion).Usually, I start with pyridostigmine, with gradual titration of dose up to approximately 240 mg (60 mg 4 times a day). Higher doses are not likely to provide additional benefit, and cholinergic ...
How do you decide what type of spinal cord stimulator to utilize for pain control?
If by “type” we mean percutaneous vs. paddle, they each have pros and cons. Perc leads are less invasive and can have a greater craniocaudal span. Paddles can be more power efficient, have more programming options in a mediolateral dimension, but are more invasive to place. I generally favor paddles...
How do you counsel patients interested in primary prevention of MS?
While there is now general consensus regarding the role of EBV infection as a trigger of disease, to date, EBV vaccines are not available and haven't been shown to prevent disease. Similarly, there is evidence of a relationship between low vitamin D and MS, though data related to prenatal supplement...
How well does a negative non-contrast MRI of the brain exclude metastasis in a patient with squamous cell carcinoma of the lung?
I don't think the question has enough information to give a good answer. For example, if it was a T3, N2 NSCLC, or a small cell, then "yes" I'd repeat the MRI with contrast. On the other hand, if it was a T1, N0 NSCLC, then "no", I wouldn't. In other words, if I thought there was a real risk of havi...
What tools do you use to evaluate for cognitive deficits in young patients?
I typically screen patients for the usual suspects when the working memory is the complaint. These include poor sleep quality, pain anywhere in the body, stress, anxiety/depression. These factors distract the brain and make it difficult to focus and perform cognitively. By addressing these factors, ...
How safe and effective is carotid stenting in carotid dissection?
Stenting in the setting of carotid dissection can be safe and effective, particularly when performed in the appropriate clinical context. The most common scenario where I consider stenting is during a tandem lesion associated with an LVO, where EVT is already being performed. In this setting, dissec...
When do you consider cardiac CT to evaluate for etiology of acute ischemic stroke?
I do it in place of TEE in: Patients with LVO or severe stenosis, for whom I am concerned about hypoperfusion causing another stroke. Elderly patients that may have a higher complication risk from TEE. I am mainly looking for intracardiac thrombus.
What resources do you find helpful for patients with MSK concerns who may not have access to physical therapy or who cannot afford it?
This is an excellent question and important because every MSK concern needs some form of exercise intervention for maximum benefit/recovery. In some (most?) EMR systems, general, basic home exercise programs (HEP) are available for patients. This is a convenient way to get patients started. Rarely, ...
Is it safe to use monthly injectable CGRP antagonists with oral gepants in the same patient?
Yes. To my knowledge, there is no data to suggest that it is not. I have routinely used oral gepants as abortive treatment in patients who are on a CGRP monoclonal antibody for prevention.There have been at least 2 retrospective studies looking at the safety and tolerability of using oral gepants in...