Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Do you always biopsy patients who present with classic skin findings of dermatomyositis?
I actually very rarely perform a skin biopsy to confirm dermatomyositis, much like I rarely biopsy classic psoriasis or classic eczema. Because I see dermatomyositis frequently enough in my practice, most times, I can confidently diagnose it by physical examination alone. I reserve performing skin b...
Is there any contraindication to the use of ezetimibe in patients with a history of statin-induced necrotizing myopathy?
These types of questions are always great to discuss. The reality is there is a risk-benefit ratio to be considered. On one hand, there is a concern for the need for lipid-lowering to prevent cardiovascular disease, and some situations are more pressing than others. A diabetic with a known cardiovas...
How do you manage the developmental and behavioral regression seen in Down Syndrome Disintegrative Disorder (DSDD)?
Thank you for this important question. One of the keys is to ensure that the change and regression being seen is DSDD or something else. Sometimes, this is confused with Alzheimer's seen in older individuals with Down syndrome. DSDD is seen in much younger people, late teens, and 20's as a more rapi...
When would you consider intra-arterial thrombolysis for acute ischemic stroke?
The prior answer brings up several valid scenarios where IA thrombolysis may be applicable. I can offer some nuanced perspective based on current practice. Device technology has advanced significantly since the landmark EVT trials of 2015. Today, EVT is increasingly feasible in distal-segment occlus...
How do you utilize FDG PET in the evaluation of dementias?
FDG PET is a regional map of glucose utilization in the brain. It tends to show reduced activity in specific areas in early Alzheimer's disease. It can complement MRI, which shows patterns of atrophy, rules out strokes, etc. Neither test is biologically specific for AD, which would require an amyloi...
How do you manage patients with glossopharyngeal neuralgia?
Glossopharyngeal neuralgia can be managed similar to trigeminal neuralgia (TN). It presents with pain like TN but located in the glossopharyngeal distribution (posterior part of the tongue, tonsillar fossa, pharynx, or angle of the lower jaw and/or in the ear). Note that neuralgia of the superior la...
Would you avoid triptans in patients with CADASIL?
Most patients with CADASIL have migraines with aura (including hemiplegic migraine and the severe form known as CADASIL encephalopathy). There is no evidence contradicting the use of triptans in CADASIL specifically. However, smaller studies and systematic reviews, and meta-analyses have shown that ...
When do you consider long-term anti-seizure medication for patients who have an acute symptomatic seizure in the setting of a cerebrovascular event?
The question is really which patients who suffer acute symptomatic seizures are at the highest risk of epilepsy and therefore may require long-term antiseizure medication.This recent paper from Neurology Clinical Practice by Sivaraju et al., PMID 39185097 can help shed some light on stratifying thes...
How do you manage cramps in patients with ALS?
Cramps are an extremely common symptom in patients with ALS; one survey study out of Wake Forest noted 95% of their ALS patients had cramps at some point in their history (1), and my clinical population is in the similar range. Despite this, many treatments for cramps do not have a robust evidence b...
What considerations should you discuss with patients prior to genetic testing for suspected Huntington disease?
Genetic testing for Huntington disease (HD) is dependent on several factors, including age, family planning, and the genetics of family members known to have the disease. For example, if someone in the family has a known mutation in the HTT gene, and the individual you are assessing has signs of HD,...