Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
When do you consider long-term anti-seizure medication for patients who have an acute symptomatic seizure in the setting of a cerebrovascular event?
The question is really which patients who suffer acute symptomatic seizures are at the highest risk of epilepsy and therefore may require long-term antiseizure medication.This recent paper from Neurology Clinical Practice by Sivaraju et al., PMID 39185097 can help shed some light on stratifying thes...
How do you manage cramps in patients with ALS?
Cramps are an extremely common symptom in patients with ALS; one survey study out of Wake Forest noted 95% of their ALS patients had cramps at some point in their history (1), and my clinical population is in the similar range. Despite this, many treatments for cramps do not have a robust evidence b...
What considerations should you discuss with patients prior to genetic testing for suspected Huntington disease?
Genetic testing for Huntington disease (HD) is dependent on several factors, including age, family planning, and the genetics of family members known to have the disease. For example, if someone in the family has a known mutation in the HTT gene, and the individual you are assessing has signs of HD,...
In patients with medically-refractory left temporal epilepsy, and left dominant language and memory, how should you approach surgical intervention?
Dominant temporal lobe epilepsies are often not candidates for hippocampal ablation or anterior temporal lobectomy because the risk for memory decline is deemed to be too high. Although having left temporal lobe epilepsy does not rule out the possibility of a resective/ablative surgery, in your part...
When do you check neurofilament light chain in patients with neurodegenerative illnesses?
Neurofilament light chain polypeptide is a protein that can be released in blood or CSF during (active) injury to nerve axons in the CNS. Until recently, this was exclusively a research tool, and in the last 5-6 years we saw an explosion of publications, demonstrating the utility of this biomarker, ...
How do you use total IgG levels, if at all, to guide plasma exchange for myasthenia gravis exacerbations?
I do not routinely measure total IgG levels before the first and after the last session of PLEX in MG exacerbations, and I do not use this lab to determine the number of required PLEX sessions, but I understand the rationale of the question, and I believe that this topic requires further study. I on...
When do you use MRI to further evaluate patients with non-traumatic subdural hemorrhage?
No, I do not.
When do you consider attributing isolated psychosis to an acute ischemic stroke?
Though relatively rare, systematic reviews have found post-stroke psychosis to occur in just under 5% of patients. When considering attributing psychosis to an acute stroke, there are several things it can be helpful to consider: Differential diagnosis: Making sure to rule out more common etio...
How does the mechanism of trauma in post-traumatic headache influence counseling of patients and their families?
If I understand the question correctly, the mechanism of PTH is important in the sense that it is needed for the diagnosis. After establishing that there was a trauma responsible for the phenotype and headache characteristics of the patient, counseling of patients and families may include screening ...
In a young patient with recurrent low-grade glioma s/p gross total resection, is there any role for further observation instead of radiation and chemotherapy?
As simple as this question seems to be on the surface, it is actually a very difficult clinical scenario to opine with certainty, primarily because of a lack of data. So, let us address this with each option in mind, weighing the pros and cons: Observation: We do know that in resected patients, radi...