Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Have you found sphenopalatine blocks to be an effective treatment for headaches secondary to subarachnoid hemorrhage?
Anecdotally, yes, but we have only been doing this as part of a small research project at our institution. The literature is largely limited to case reports and there is at least one clinical trial (NCT07116408) looking specifically at this, scheduled to finish enrollment in 2026. There are commerci...
How long would you continue chronic transfusion therapy for adult sickle cell patients who have had a stroke?
There is no high-level evidence to inform the decision of how long to continue chronic transfusion in this scenario. Decisions on whether to continue indefinitely are affected by multiple factors like the presence of RBC alloimmunization, whether the patient was on hydroxyurea at MTD or not at the t...
How do you manage autonomic symptoms in patients with myasthenia gravis?
MG is a pure motor syndrome. Patients should not have any autonomic symptoms unless they have LEMS (dry mouth) or if it is medication-related (e.g., Mestinon’s SE includes excessive salivation, sweating, and GI hypermotility). Thus, if a patient with MG has autonomic symptoms (unless explained by LE...
Which non-pharmacologic treatments for neuropathic pain have you found most effective?
There is data supporting a positive role for lifestyle changes, primarily physical exercise, suggesting that consistent engagement can reduce neuropathic pain. They included aerobic, resistance, and balance programs for anti-sedentary behavior.
Is the p-tau217 plasma test used as a surrogate for amyloid PET scan or CSF testing when considering starting Leqembi in patients with Alzheimer's disease?
P-tau127 is an excellent surrogate for amyloid, though it is not yet standard practice. Currently, there are no best practice guidelines on whether p-tau217 alone is sufficient or if it needs to be combined with Aβ42/Aβ40 or APOE4. These are available clinically but not yet FDA-approved. The FDA-app...
When do you consider thrombectomy for patients with LVO and carotid dissection?
In most situations, unless there is no deficit, NCCT shows ICH, or CTP shows no significant penumbra. Dissection in itself is not a contraindication to thrombectomy.
Would a longstanding diagnosis of multiple sclerosis impact your radiation recommendations for a patient with breast cancer?
In my opinion, the simple answer is no. At least not in my experience treating one MS patient with whole breast radiation. Unlike Scleroderma, which is an autoimmune disease that can result in inflammation and thickening of the skin, connective tissues, and internal organs, MS is an autoimmune disea...
Can anti-cardiolipin or anti-beta-2 glycoprotein antibodies cause prolonged PTT in the absence of a lupus anticoagulant?
Lupus anticoagulants are a heterogeneous group of antibodies that do not have uniform activity in all assays. Furthermore, testing procedures are not well-standardized. Since relevant clotting factor deficiencies have been ruled out and the long PTT does not correct with mixing, and since there is o...
When is air travel safe for patients with recent diagnosis of ischemic stroke?
Air travel on a modern commercial jet includes full pressurization and oxygenation, such that I see minimal or no risk to air travel. Flying on a small, private plane would have higher risk, so I would wait longer for that, perhaps even a month. During helicopter flights for acute stroke patients, o...
What is your preferred site for central venous access in patients with concern for raised intracranial pressures?
Subclavian is our preferred central venous access for raised ICP, but we also utilize femoral lines for patients at high risk of pneumothorax or who need more emergent access. We have historically avoided IJ lines because of concern for impeding venous drainage by blocking the IJ. I do not think thi...