Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you handle medication management for patients on immunosuppressive therapy who are lost to follow-up?
I typically require one clinical visit at least once a year at minimum to continue prescribing immunotherapy, with a grace period of a few months. If they are lost to follow-up, I cannot ensure safety or clinical efficacy, nor address symptoms or comorbid conditions that worsen their disease. Our te...
What are your top takeaways from ISC 2025?
We had hoped that medium-sized vessel occlusions (MeVOs) would respond to endovascular thrombectomy (EVT) as do large vessel occlusions (LVOs), but several trials show a lack of benefit of current EVT technology for MeVOs. Patients with MeVOs (and more distal occlusions) remain a target for finding...
When do you consider using stimulants in patients with cognitive impairments secondary to traumatic brain injury?
Perhaps most importantly, prescribing medication to address cognitive difficulties conveys hope to TBI patients that even if they have suffered structural brain damage, they can improve. Though the improvement may be fairly small, it can have important implications for better general functioning. We...
When do you refer a patient with recurrent glioma for reoperation?
This question is a nuanced one that is dependent on many factors. When a patient has a recurrent glioma, the treatment options are generally re-resection, medical therapy (traditional chemotherapy or targeted agents, depending on the tumor), or radiation. Which treatment modality, or combination of ...
How do you approach the treatment of idiopathic myorhythmia?
Idiopathic myorhythmia does not always need treatment. If it is disabling, then symptomatic treatment can be offered with caution that it is not very effective. However, trying benzodiazepines, antiepileptics, and even dopaminergic medications may be useful.
What is a reasonable length of time to wait before performing a cardiac ablation for atrial fibrillation in a patient with an embolic stroke?
There is no data related to this question. If the deficits related to the stroke are mild to moderate, I would consider doing an ablation within a few weeks after an embolic stroke. With more severe deficits, I would wait longer.
What is your approach to the evaluation of minipolymyoclonus?
The term minipolymyoclonus usually describes low-amplitude arrhythmic movements of the fingers seen when the arms are outstretched, which can be seen in several conditions. The evaluation would depend on the accompanying symptoms. For example, if minipolymyoclonus is seen in the setting of weakness ...
What is the role of inpatient psychiatric or psychological evaluation in patients who have had acute function change as an inpatient?
This is an important question. An acute change in function is a frequent reason for hospital admission and must be considered as a feature of some underlying medical, neurological, or psychiatric condition. It is important to know what functions have changed, including basic and instrumental activit...
How do you approaach ischemic stroke from suspected symptomatic ipsilateral carotid web with less than 50% stenosis?
I would need to know what the definition of "suspected symptomatic" means in this setting. Is this the patient's first ischemic event? Or have there been multiple ischemic episodes? Is the stroke pattern sub-cortical/lacunar-type from uncontrolled microvascular risk factors or cortical-appearing sug...
How do you treat a mild basilar artery occlusion stroke?
I agree with the prior post and would like to add some additional insight from the interventional lens. As mentioned, NIHSS isn’t well-suited to posterior circulation strokes. From the intervention side, basilar occlusion can look deceptively mild on paper, but the outcomes are often anything but. I...