Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Do you counsel patients to acutely treat migraine with aura at the onset of aura or headache?
The timing of acute treatments for migraine attacks has been widely discussed for a number of years. Here are some principles: Once the pain begins, pain-free rates are higher if the patient treats early in the attack, while the pain is still mild. This is broadly true for triptans, NSAIDs, aspirin...
What imaging features can help distinguish between an acute versus chronic cervical internal carotid occlusion?
Distinguishing between acute and chronic cervical ICA occlusion is often challenging, but CTA and CTP can offer helpful clues in assessing lesion acuity. On CTA, contrast enhancement along the vessel wall at the site of occlusion, sometimes referred to as the "ring sign," may suggest an acute thromb...
How do you manage long-term pain associated with sensory ganglionopathy?
There is no difference in the management of neuropathic pain from sensory ganglionopathy vs. neuropathic pain caused by a typical length-dependent distal sensory polyneuropathy, like diabetic.
When do you use wearable EEG or epilepsy detection devices for epilepsy management?
We use it when there is a diagnostic question and we estimate that the chance of capturing an event in a reasonable period of time (24-72 hours) exists.
How do you approach use of DMARDs and/or biologics for inflammatory arthritis in patients with a history of seizure disorder on anti-epileptic medications?
Polypharmacy should always be a worry in our treatment of rheumatoid arthritis. Fortunately, the biologics, reflecting their immunoglobulin framework, are rarely a concern for drug-drug interactions. This is in contrast to small molecule inhibitors such as methotrexate, leflunomide, and the jak inhi...
How effective do you find lifestyle modifications in management of migraine?
Lifestyle modifications may be effective when there is a convincing relationship to identifiable triggers: food/drink, sleep deprivation/irregular cycles, exertion, stress, and/or imperfect coping mechanisms. However, even when that is the case, the extent to which accommodation constraints a normal...
What is the preferred management plan for patients diagnosed with a concussion in the acute setting?
For acute concussion, if sports related, they should be removed from play immediately and not allowed to return for the duration of the game. For any cause of concussion, it is generally accepted to avoid NSAIDs and use acetaminophen for the first 24 hours if needed for headache. After the initial 2...
How do you counsel patients interested in estrogen containing oral contraceptives who have migraine with aura?
Outside of patients whose attacks are suggestive of hemiplegic migraine, I do not typically avoid the use of estrogen-containing OCPs. While it is my understanding that a number of international organizations and many neurologists (as well as Ob/Gyn) recommend their avoidance, there are several revi...
How would you approach evaluation and treatment of a patient on pembrolizumab therapy who presents with symmetric, proximal, upper extremity and lower extremity painful weakness without an elevated CK?
Pembrolizumab, like other checkpoint inhibitors, is associated with a number of immune mediated neuromuscular syndromes including GBS/CIDP, a myasthenic syndrome, and myositis. A patient with symmetric proximal weakness and normal CK could have any of the above conditions. Normal CK does not exclude...
How do you approach treatment of vasospasm after AVM rupture?
In my practice, ruptured AVMs are managed in a way somewhat similar to aneurysmal SAH rupture. Initial DSA evaluates the AVM’s angioarchitecture and identifies high-risk features, such as intra-nidal or branch feeder aneurysms. These high-risk features are addressed during the acute phase of managem...