Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What holistic treatments do you recommend for patients with migraine without aura?
Before considering alternative or holistic treatments, first, assess whether both preventive and abortive treatments have been taken correctly and if there is no evidence of medication overuse. Cost and side effects often limit compliance. Lifestyle modification (which could be broadly considered as...
How do you counsel patients with mild congenital myopathy about exercise limitations?
There are many reasons why all patients with muscle disorders should exercise. Many studies have shown improvements in aerobic capacity and some have shown improvements in functional capacity (i.e., 6MWT). Furthermore, many patients with neuromuscular disorders tend to avoid exercise and this is a c...
Would you consider using IVIG for POTS in the absence of any clear autoimmune condition or abnormal antibodies?
I completely agree with the answer above. It would be a pretty rare consideration, overall. Recent placebo-controlled and blinded studies examining the efficacy of IVIG for idiopathic or antibody-associated (FGFR, TSHDS) small fiber neuropathy found no benefit of the treatment in terms of small fibe...
What type of visual disturbance qualifies as a visual aura?
Visual aura should be a time-limited neurologic event (5 minutes to 60 minutes) with or without migraine headache. It can contain positive (e.g., flashes of light) and/or negative (e.g., scotoma) visual phenomena. It is often toward one side of the visual field but is binocular (comes from both eyes...
Do you typically obtain an EEG in patients undergoing workup for cognitive dysfunction?
I do not obtain an EEG unless something in the patient's history leads me to suspect seizures.
What leads you to consider prescribing a nasal spray formulation for the treatment of acute migraine?
Interesting discussion. From my perspective, one of the big choices in the acute treatment of migraine is whether to give an oral or non-oral treatment. Patient preference studies show that oral agents are preferred if they work so I usually start there. Most patients prefer nasal sprays to subcutan...
Would you recommend TNK or DAPT in patients with stroke-like symptoms and NIHSS less than 5 presenting within 4.5 hours?
I agree with Dr. @Dr. First Last. The decision in patients with minor stroke rests on whether the symptoms are disabling, which in general, is based on a discussion with the patient and their family to understand how the deficit could impact the patient's career or hobbies. For disabling deficit, I ...
In what clinical settings is acute ICH clot removal recommended?
Clot removal should be performed when there is a cerebellar hemorrhage with brainstem compression and/or hydrocephalus. Clot removal can be considered as a life saving measure if there is neurologic deterioration, midline shift, or depressed consciousness. There is still uncertainty about clot remov...
How do you manage patients with ice-pick headaches?
Ice-pick headaches, previously known as jabs & jolts and now often referred to as stabbing headaches, also manifest as stabbing face pain, which can be mistaken for trigeminal neuralgia due to lack of awareness. They can strike the head or the face suddenly, resembling lightning bolts. While common ...
When would you consider treatment with steroids in patients with diabetic radiculoplexus neuropathy?
Steroids (pulse IV methylprednisolone) are the only treatment for diabetic amyotrophy supported by randomized placebo controlled trial (Dyck PJB et al., Neurology 2006; 66(5, Suppl 2):A191.) The soonest the treatment is started after onset of symptoms, the best. I will treat most patients presenting...