Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you manage incidentally found venous sinus thrombosis?
I would make sure first that it is not simply a congenitally small sinus. If there is truly a CVST, I would probably treat with a DOAC for 3 months and reassess with CTV.
How do you wean off of primidone in patients with essential tremors?
If a patient has been on primidone for less than one month, it can be simply discontinued in most cases. Slower withdrawal may be necessary in patients with seizures, patients on multiple other medications, or with other abnormal metabolism. For patients needing a slower taper, generally lowering th...
How do you decide when to extend rituximab redosing beyond a 6 month interval for replasing multiple sclerosis?
In light of the published study, the discussion that I've had with patients revolves around utilizing CD19/CD20 counts to guide infusion frequency.
How do you work up patients who present with elevated myoglobin in the setting of normal creatinine kinase and exercise intolerance?
Myoglobin may originate either from cardiac or skeletal muscle; therefore, I would first try pinpointing the origin with troponins and CK fractions. I would work up the exercise intolerance with a non-ischemic forearm test to determine whether a flat lactate curve is present. In that case, I’d typic...
When do patients with descending paralysis and suspected botulism require inpatient EMG?
If a health care provider suspects botulism in a patient presenting with descending paralysis (beginning from the cranial/bulbar region) and certain clues such as autonomic nerve involvement with dilated poorly reactive pupils, constipation, etc. can help, then treatment must be administered immedia...
When should we order a DaT scan in patients suspected of Parkinsonism syndrome?
I believe that a good clinical examination can tell you if a patient has parkinsonism or not and that is the same answer one gets from a DaTscan. If the findings are too subtle, then re-examine the patient at intervals. So my answer is it is not necessary. I emphasize "my" answer because not everyon...
What are your recommendations for screening for sleep disorders in patients with IDD?
Sleep disorders are very common for people with IDD. One consideration, in particular, is in patients with Down Syndrome because of the shape of their mouth and large tongue. They have a very high rate of sleep apnea, obstructive sleep apnea in particular, which can be seen even in children. You wo...
Does global brain atrophy increase risk for intracranial bleed after fall in older adults?
It depends on the location of the hemorrhage. Subdural bleeding/hematoma is much more likely in elderly people with brain atrophy and a fall. Epidural hemorrhage is much more common in young patients. Intracerebral hemorrhage is more related to risk factors such as hypertension in middle age and amy...
What MRI findings would you consider compatible with an acute seizure or seizures?
Frequent seizures and status epilepticus can result in reversible neuroimaging findings such as cortical enhancement, DWI cortical ribboning, and decreased attenuation on CT. Imaging findings can be resolved with control of seizures.Hormigo et al., PMID 15023812Kramer et al., PMID 3653056Riela et al...
How do you determine if generic vs. brand formulation of a DMT is the probable cause of worsening multiple sclerosis disease activity?
I based this on the timing of the switch to generic formulations and the duration of stability on brand formulation. For example, if a patient has been on brand DMT with stability for 5 years, then recently changed to generic with disease activity within the first year, I would consider that the gen...