Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What resources do you find helpful for patients with MSK concerns who may not have access to physical therapy or who cannot afford it?
I would recommend that all primary care providers purchase a copy of “The Sports Medicine Patient Advisor” by Pierre Rozier (now 3rd edition). It is entirely comprised of handouts with permission to copy for patients. That is my go-to resource for patients. I’ve used a version of it since my fellows...
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...
What have you found helpful in counseling patients with migraine reluctant to take preventative medications?
I think all of the responses here are very reasonable, but often the hesitancy is based less on resistance to a specific medication than on the self-stigmatization we see in patients with chronic headache, migraine, or other primary or secondary headaches. Because migraine is not a life-threatening ...
What is the utility of a hypercoagulability workup in recurrent cryptogenic stroke, and what specific tests would you recommend?
Ambulatory monitoring for AFib is probably more helpful than such a thorough clotting workup.
What traditional or herbal medications do you regularly screen for in migraine patients?
I do not particularly screen for any. I go over the medicine and supplement/vitamin list that they are taking. I counsel patients on the option of using OTC vitamins/supplements for migraine disorder prevention. I routinely counsel on magnesium 500 mg daily, riboflavin 400 mg daily, and coenzyme Q10...
What techniques do you use to help reduce procedural pain for headache injection treatments?
In my clinic, none of the providers, to my knowledge, use any specific techniques to reduce procedural pain. We do offer ice packs that patients can use during or after a procedure. We do Botox and pericranial nerve blocks. It would be difficult to coordinate using REN prior to procedures. I suppose...
How do you decide when to discontinue immunotherapy for primary angiitis of the central nervous system (PACNS)?
I take a multidisciplinary approach with involvement of my neurobiology and rheumatology colleagues for the immunotherapy. PACNS can be relapsing or remitting. So needs close monitoring with radiologic (MRI and MRA high resolution vessel wall imaging or CTA/MRA with CSF studies 6 months and then 1 y...
How do you decide when to treat transient global amnesia with antithrombotic therapy?
Most cases are idiopathic and do not require treatment. However, as we had earlier reported in 1086, TGA secondary to ICH. Similarly, there can be other etiologies precipitating TGA, including ischemic stroke. Antithrombotic therapy will be useful in cases precipitated by an ischemic stroke/ TIA. Th...
How can I incorporate neuromuscular ultrasound into my practice with limited prior experience?
I think it's awesome when anybody is willing to implement a new tool into their established clinical workflow. My suggestion, if you are already an EMGer, would be to start small and simple with a focus on upper extremity focal neuropathy and practice, practice, practice.Carpal tunnel syndrome and u...
Would you use a lumbar drain in a patient with spinal stroke from fibrocartilagenous embolism?
There are no clinical trials to suggest any benefit. Smaller studies - particularly case series have shown some benefit with the use of lumbar drain in the first 48 hours and keeping the pressure around 10 mmHg. These include mostly patients post a cardiovascular surgical procedure as a cause in the...