Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Are you offering Lutathera for multiple recurrent meningiomas?
Lutathera is currently only FDA-approved for treating somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). However, research is ongoing to explore its potential use for meningiomas, as many meningiomas express somatostatin receptors, which could make it a promising...
How do you determine when patients can resume their previous activities after a subdural hemorrhage?
First, it depends on the status of the SDH; if surgically removed or with embolization of the middle meningeal artery, then return to activity can be fairly rapid, over 2-3 weeks if gradually increasing, but if no surgery or intravascular procedure, then I would advise more caution. This would mean ...
When should MOG-Ab be tested in patients with suspected autoimmune encephalitis with seizures and normal MRI?
In someone with suspected autoimmune encephalitis with seizures and a normal MRI (presuming done with gadolinium and the optic nerves are well visualized), I would not obtain MOG. MOG testing would have a very low pretest probability (so low that a positive test might well be a false positive). If o...
What are potential pitfalls in the use of OCT to support a diagnosis of multiple sclerosis?
OCT used to support a diagnosis of MS must be used with care and with substantial knowledge of OCT and its artifacts. OCT shows retinal nerve fiber layer and retinal ganglion cell damage. There are no OCT findings specific for multiple sclerosis. Therefore, OCT must be interpreted in concert with an...
How do you determine when patients can resume massage therapy, weight lifting, or sports after a spontaneous CSF leak?
I have seen cases where athletes return to intense activity too soon after a blood patch and have a repeat leak. There is guidance from Duke Health that I have used as a guideline when advising patients on resuming activity.
How do you approach new-onset idiopathic intracranial hypertension (IIH) with someone who has history of systemic lupus erythematosus?
Since there is not a clinical recurrence of lupus, let's assume the disease is quiescent. The patient may have a clotting tendency so extra care should be taken in MRV interpretation. Does the MRV show the smooth-walled flow-related stenoses of intracranial hypertension or is it more consistent with...
How do you evaluate and diagnose patients with persistent postural-perceptual dizziness?
There are certain criteria. Staab et al., PMID 29036855. There is an identifiable event that is usually disorienting. This can be a vestibular event (vestibulitis, BPPV, vestibular migraine attack), mechanical fall, panic attack, among other events. There is significant head motion sensitivity and v...
What is your approach for treating mononeuritis multiplex in patients with ANCA vasculitis?
Mononeuritis multiplex related to ANCA associated vasculitis generally responds to treatment with rituximab, which would be my treatment of choice. Clinicians need to be aware that neurologic recovery can be very slow, and it is important to distinguish damage from ongoing active nerve inflammation....
What is your approach for LINAC based radiosurgery when dealing with benign perioptic lesions very close to the optics apparatus?
It all starts with the consideration of what I consider an effective dose of SRS or SRT (hypo-fractionated SRS). The minimum effective dose to achieve local control of a metastatic lesion is usually 18 Gy for single fraction, 27 Gy for 3 fractions, and 30 Gy in 5 fractions.I then consider the histol...
Do you make any dose adjustments for patients with ESKD who are on apixaban and do not otherwise meet criteria for reduced dosing?
I do most of the time but it depends on the indication and patient's weight and age. For soft indications, I usually give 2.5 mg bid, but if there is a significant risk (stroke, clots, etc), I will give a full dose of 5 mg bid.