Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you counsel B cell-depleted multiple sclerosis patients on the benefits of regular COVID-19 vaccinations?
The fact that B cell-depleted patients render a blunted antibody response is not unexpected, but antibodies do not protect from viral infections - cells do. To measure a proper vaccine response, one wants to test T cells from patients to see if they are able to kill viral infected cells. This is wha...
What primary and secondary stroke prevention strategies do you use for patients with a pulmonary AVM (PAVM)?
This is not a common problem in stroke neurology. I have been involved in this problem for a patient with HHT (also known as Osler-Weber-Rendu syndrome). Sporadic or post-surgical AVMs may also arise but they are uncommon. In general, the treatment in both scenarios (primary and secondary prevention...
When would you start antiepileptic drugs in a critically ill patient who develops myoclonic jerks but has not yet had an EEG?
Treatment depends on the setting in which these myoclonic jerks are seen. In a non-cardiac arrest patient, such myoclonic jerks are often due to medications, organ dysfunction (e.g., uremia, etc), electrolyte imbalance, or non-convulsive seizures, etc, and workup for this is recommended with labs, h...
When would you consider GLP-1 receptor agonists for IIH in patients at a healthy weight and BMI?
Randomized clinical trial data demonstrate that exenatide (exendin-4), a GLP-1 receptor agonist, reduces ICP in women with active IIH, with reductions of approximately 5–6 cm water of CSF and no serious side effects; this result is both statistically and clinically significant. This pressure-lowerin...
How do you approach treatment of 1p19q non-codeleted high grade gliomas?
The question focuses on the management of 1p19q non-codeleted high-grade gliomas, which for all practical purposes translates roughly to the entity that by legacy terminology has been referred to as anaplastic astrocytoma. This question has come into focus with the recent publication of results of t...
How would you manage a CVST secondary to a traumatic brain injury with the presence of intracranial hemorrhage?
When dealing with CVST after TBI, the mechanism of injury is not the same as a spontaneous CVST. There is often direct injury to the vein or the area overlying it. Given that these patients often have other traumatic injuries, and given the lack of clear evidence to support one therapy or another, I...
What is your approach to titration of sublingual cyclobenzaprine in your patients with fibromyalgia?
Follow the FDA instructions: start at 2.8 mg sublingually at bedtime for 14 days, if tolerating, then increase to 5.6 mg nightly starting day 15 onwards. Ensure the mouth is not too dry as saliva is needed for it to fully dissolve, which could take 2-3 mins. This may be a concern in patients with SI...
How do you evaluate and manage brain fog in patients with underlying rheumatic disease?
For Brain fog – Most important this is I stress to patients – there are likely MULTIPLE different things contributing to brain fog, so there are MULTIPLE different things we are going to have to work on to improve it. Active inflammation might be contributing, but there is likely several other facto...
How do you use Boswellia for radiation necrosis?
I reached out to my colleague, naturopath Lise Alschuler, Associate Director of the University of Arizona Fellowship Program in Integrative Medicine program, for her thoughts on this question. Here is her answer:This study by Upadhyay et al. is a well-designed study which builds upon earlier studies...
How do you treat agitation in progressive supranuclear palsy?
Benzodiazepines are generally avoided due to adverse effects on cognition, the increased risk of falls, and disinhibition.Pharmacologic treatment for agitation is generally reserved for patients with severe agitation, when a patient is a threat to themselves and others, when agitation is the cause o...