Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
In patients with medically-refractory left temporal epilepsy, and left dominant language and memory, how should you approach surgical intervention?
Dominant temporal lobe epilepsies are often not candidates for hippocampal ablation or anterior temporal lobectomy because the risk for memory decline is deemed to be too high. Although having left temporal lobe epilepsy does not rule out the possibility of a resective/ablative surgery, in your part...
When do you check neurofilament light chain in patients with neurodegenerative illnesses?
Neurofilament light chain polypeptide is a protein that can be released in blood or CSF during (active) injury to nerve axons in the CNS. Until recently, this was exclusively a research tool, and in the last 5-6 years we saw an explosion of publications, demonstrating the utility of this biomarker, ...
How do you use total IgG levels, if at all, to guide plasma exchange for myasthenia gravis exacerbations?
I do not routinely measure total IgG levels before the first and after the last session of PLEX in MG exacerbations, and I do not use this lab to determine the number of required PLEX sessions, but I understand the rationale of the question, and I believe that this topic requires further study. I on...
When do you use MRI to further evaluate patients with non-traumatic subdural hemorrhage?
No, I do not.
When do you consider attributing isolated psychosis to an acute ischemic stroke?
Though relatively rare, systematic reviews have found post-stroke psychosis to occur in just under 5% of patients. When considering attributing psychosis to an acute stroke, there are several things it can be helpful to consider: Differential diagnosis: Making sure to rule out more common etio...
How does the mechanism of trauma in post-traumatic headache influence counseling of patients and their families?
If I understand the question correctly, the mechanism of PTH is important in the sense that it is needed for the diagnosis. After establishing that there was a trauma responsible for the phenotype and headache characteristics of the patient, counseling of patients and families may include screening ...
In a young patient with recurrent low-grade glioma s/p gross total resection, is there any role for further observation instead of radiation and chemotherapy?
As simple as this question seems to be on the surface, it is actually a very difficult clinical scenario to opine with certainty, primarily because of a lack of data. So, let us address this with each option in mind, weighing the pros and cons: Observation: We do know that in resected patients, radi...
What are red flags in an evaluation for possible multiple sclerosis that should prompt workup for genetic/inherited conditions?
Clinical red flags: Chronic, progressive course, developmental regression preceding presenting event, positive family history of similar symptoms, other organ involvement such as diabetes, sensorineural hearing loss, cardiomyopathy, GI dysmotility, rapid bilateral vision loss without other evidence ...
When is a paraneoplastic panel indicated when working up patients with neuromuscular conditions?
Is there any benefit from oral vs topical steroids in herpes zoster opthalmicus?
The role of steroids in uncomplicated herpes zoster is limited, but weak evidence suggests they may provide some symptomatic relief. However, oral and topical steroids may have a role in complicated zoster, including cases with ocular involvement/HZO, when used with antiviral therapy, especially if ...