Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you manage headaches in stroke patients?
In general, I treat headaches based on phenotype. If they have associated migraine features then I treat them with migraine medications. If tension type then I address all the headache hygiene components. If cervicogenic then physical therapy for these. Always screen for and counsel on medication ov...
How do you manage incidentally found venous sinus thrombosis?
I would make sure first that it is not simply a congenitally small sinus. If there is truly a CVST, I would probably treat with a DOAC for 3 months and reassess with CTV.
What is your approach to the management of Bell's palsy that has not improved after six months?
My understanding is that 'Bell's palsy' means idiopathic facial palsy. Therefore, I usually evaluate for other causes, depending on the clinical scenario, before calling it Bell's palsy. We see a lot of Lyme disease in PA. Facial palsy may be the initial manifestation of neurosarcoidosis and may res...
How do you approach patients with positive LRP4 antibodies without clinical findings of myasthenia gravis?
This is an interesting question. Another interesting one is what was the ordering physician looking for when they ordered LRP4. Myasthenia gravis is a clinical diagnosis. As a neuro-ophthalmologist, I see a high volume of both ocular and generalized myasthenia. I personally do not base my diagnosis ...
What workup do you recommend for isolated postural and action tremors in a developmentally typical toddler?
Rule out Wilson's Disease. 24-hour urine copper, ceruloplasmin, consider further testing, definitely monitor for progression of other symptoms.
How do you approach interval monitoring of cavernous carotid aneurysms?
Cavernous carotid aneurysms are typically extradural in location. While they carry some rupture risk depending on size and morphology, they are less likely to cause SAH and more likely to hemorrhage into the cavernous sinus (e.g., CCF). Although any intracranial hemorrhage is concerning, bleeding in...
Do you consider stopping zonisamide in a female patient with epilepsy who becomes pregnant?
There is nothing specific to zonisamide in this matter and the same question applies to any ASM except basically VPA. Should we stop the ASM if the woman becomes pregnant? I have never understood this question. If it's considered possible to discontinue the ASM due to pregnancy, it suggests that she...
Would you change an elderly, frail patient with atrial fibrillation who is already on a NOAC to VKA treatment?
I wouldn't on the basis of this study. Aside from the other limitations of the FRAIL-AF trial, this study only addressed the utility of switching a stable patient from VKA to NOAC and not vice versa. A patient who is doing well on an appropriately dosed NOAC may experience difficulty achieving adequ...
Do you get volumetric MRI in all patients with cognitive difficulties?
Yes, I find MRI very useful in assessing patterns of atrophy, as well as the degree of vascular changes in the brain. It can help confirm suspected diagnoses such as frontotemporal dementia or Alzheimer's disease.
Would you administer IV thrombolysis in a patient presenting with disabling stroke symptoms while on anti-amyloid therapy?
I agree with @Dr. First Last. There seems to be one case of catastrophic bleeding in the published literature. However, such events can occur with thrombolysis alone or in the context of other cerebrovascular conditions such as CAA, vascular malformations, and even severe WMH. While it's important t...