Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
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...
Have you found FcRn inhibitors effective for weaning off or replacing IVIG for the treatment of refractory seropositive myasthenia gravis?
I think efgartigimod can be considered as an alternative to IVIG in sero-positive generalized MG, especially in patients who experience severe side effects from IVIG or contraindications due to cardiac, renal dysfunction or clotting disorder.One of the proposed mechanisms of IVIG is by overwhelming ...
Do you use sitting vs supine spirometry to consider tracheostomy in a patient with Amyotrophic Lateral Sclerosis?
The decision to pursue tracheostomy is becoming less of a choice altogether in our practice. However, to answer your question once my patients are on NIPPV I don't routinely subject patients to supine spirometry for prognostic follow-up, given the high risk-benefit ratio of transferring a patient wi...
How do you select patients with spontaneous intracerebral hemorrhage for minimally invasive surgical hematoma evacuation, if offered at your institution?
Disclosure - our institution is conservative in its approach to surgical management of ICH, as we don't seem to have the supportive evidence to warrant large-scale application. With that, we take all cerebellar ICH with depressed level of consciousness or NIHSS >4. We consider cortical hemorrhages o...