Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
For trigeminal neuralgia in patients with multiple sclerosis, do you consider microvascular decompression or stereotactic radiosurgery as treatment options?
Secondary trigeminal neuralgia attributed to multiple sclerosis occurs when there is an "MS plaque at the trigeminal root entry zone or in the pons affecting the intrapontine primary afferents" according to ICHD-3. Note that according to ICHD-3 "Pontine lesions affecting the second order neurones of...
Based on the FIREFLY-1 data, would you consider using tovorafenib monotherapy front-line in pediatric patients who have low grade gliomas that are only amenable to subtotal resection or are unresectable?
Not yet. I think it is important to wait for the results of FIREFLY-2 and also ACNS1831/ACNS1833. We have to keep in mind that the combination of trametinib and dabrafenib is already FDA-approved as frontline treatment for paediatric patients with BRAF V600 mutated LGG. This approval was based on th...
How would you prioritize physiotherapy and cognitive behavioral therapy for functional movement disorders in a resource-limited setting where access to both might be constrained?
I have a dedicated clinic for people with functional movement disorder/functional neurologic disorder (FMD/FND) in New York City and even in a city like New York, it is difficult or actually impossible to refer patients for appropriate therapy.For some people with rather straightforward cases, a ref...
What is the appropriate workup and treatment for patients with SMART syndrome following radiation for brain tumors?
Stroke-like migraine attacks after radiation therapy (SMART) is a late presentation after treatment for a CNS malignancy (or brain radiation for another cause; e.g., prophylactic cranial radiation). It is one of many late effects of radiation therapy. Others may include vasculopathy, cognitive dysfu...
What factors would guide your decision to safely resume anticoagulation for atrial fibrillation following a recent intracranial hemorrhage?
Whether a patient with atrial fibrillation and an intracerebral hemorrhage should resume anticoagulation depends on whether the bleed was attributed to cerebral amyloid angiopathy (CAA). Most patients with CAA should not be on long-term (lifelong) anticoagulation. If a bleed was attributed to hypert...
How do you explain the clinical benefit of lecanemab or donanemab to patients?
I do feel that the study outcomes are clinically meaningful, especially for patients with mild cognitive impairment due to AD. A clinically meaningful outcome is the ability to stay at an early symptomatic stage for a longer time than the natural history of the disease would otherwise allow. It appe...
How do you adjust the management of epilepsy in patients who are planning to fast?
Great question! During Ramadan, Muslims fast from dawn to sunset. They can take their medications before dawn and after sunset. In most cases, they can continue their current bid regimen without having to change to extended-release. Remind them of the importance of maintaining a good sleep schedule ...
Can giant cell arteritis present with a partial cranial neuropathy?
Giant cell arteritis (although giant cells on temporal artery biopsy are not a sine qua non) most typically presents to the neuro-ophthalmologist with ischemic optic neuropathy (usually anterior and sometimes posterior).Ophthalmoplegia is uncommon in GCA but has been attributed to oculomotor and abd...
What is your approach to the treatment of visual snow syndrome?
Visual snow is not a syndrome. It's a symptom that consists of static vision. I opine that it's origin is retinal (not brain) and that it relates to ongoing activity. In the past I have referred to it as retinal repolarization disorder. It should not be confused with migraine aura status, which is a...
What is the utility and yield of CSF studies for orbital apex syndrome?
"Orbital apex syndrome" is a description of WHERE the problem is. It is a specific pattern of localization - i.e., some combination of CN III, IV, V1, V2, or VI, along with evidence of optic neuropathy (CN II) - that indicates that there is pathology anterior to the cavernous sinus (because the opti...