Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What is the first line therapy for demyelinating neuropathy with positive NF-155 antibodies?
Neurofascin-155 IgG antibody-associated neuropathy is a subtype of neuropathy with electrophysiologic features suggestive of demyelination, but distinctly different pathogenesis from classic CIDP, and also distinctly different response to treatments. Unlike CIDP where the target of the immune attack...
Do you consider DBS for Essential Tremor in patients who already underwent Focused Ultrasound Thalamotomy?
In patients with medication-refractory essential tremor, ablative thalamotomy (with focused ultrasound stereotactic surgery, or gamma knife) and deep brain stimulation (DBS) are effective methods for the management of tremor. Ablative thalamotomy with focused ultrasound uses acoustic energy for remo...
Would you use bupropion for mood disorder or substance use in an adult patient with previous childhood seizures that resolved?
The short answer is maybe, though it would not be my first choice. Bupropion is known to lower the seizure threshold, thus the basis of the question. Selection of an antidepressant depends on multiple factors including response to prior medications, side-effect profile, cost, presence of comorbid sy...
How would you approach antithrombotic therapy in patients with acute ischemic infarcts and a non-occlusive intracranial thrombus?
I agree with the previous answer and can expand on a few key management nuances involving stroke size, symptom severity, and etiology. For stroke size, I typically initiate anticoagulation (heparin drip) if less than one-third of the affected territory is involved, extrapolating from tPA guidelines....
How clinically meaningful are the differences in the primary outcome between treatment and placebo groups in the CENTAUR trial?
Defining the term "clinically meaningful" proves challenging. Patients involved in the three positive and approved drug trials are unable to detect a slowdown in the progression rate. Attempts were made to gauge ALS providers' opinions regarding a meaningful change in the ALSFRS-R scale, suggesting ...
Would you offer adjuvant radiotherapy for a gross totally resected WHO grade 2 hemangiopericytoma/MFT of the brain in a patient with active multiple sclerosis?
This is a tough question to answer, as there are risks associated with either recommending post-operative radiotherapy or not. Hemangiopericytomas are rare intracranial tumors that arise from pericytes, support cells found in the wall of meningeal capillaries. They are part of a larger spectrum of m...
For patients with newly diagnosed brain metastases without a history of seizure activity, do you routinely start anti-seizure medication?
This is a common clinical question that has been repeatedly explored in meta-analyses and clinical guidelines. Consistently, there's no evidence to support primary prophylaxis for seizures in patients with brain tumors including brain metastases. In summary, the data does not support the routine use...
Would you recommend anticoagulation in a pediatric patient with metastases in a dural venous sinus?
For an adult patient would consider if there is evidence of tumor-associated thrombus on initial imaging or follow-up, but not usually from a prophylactic perspective. This may be different in a pediatric patient and also might depend on the primary malignancy or hematologic, or neurologic comorbidi...
What are your preferred anti-seizure medications for Doose syndrome?
Meds are not listed in any necessary order: valproic acid, clobazam (any other benzo), ketogenic diet, and felbamate. The ketogenic diet and felbamate are the most effective.
How would you approach the workup of unilateral chorea with a normal MRI?
I would first rule out Sydenham chorea by checking ASO titers, DNase B titers, ESR, and CRP, and performing an echocardiogram and EKG. I would also recommend an MR angiogram if not already done for Moya-Moya. Following that, I would check copper levels, ceruloplasmin, serum amino acids, serum lactat...