Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you handle medication management for patients on immunosuppressive therapy who are lost to follow-up?
I typically require one clinical visit at least once a year at minimum to continue prescribing immunotherapy, with a grace period of a few months. If they are lost to follow-up, I cannot ensure safety or clinical efficacy, nor address symptoms or comorbid conditions that worsen their disease. Our te...
What are your top takeaways from ISC 2025?
We had hoped that medium-sized vessel occlusions (MeVOs) would respond to endovascular thrombectomy (EVT) as do large vessel occlusions (LVOs), but several trials show a lack of benefit of current EVT technology for MeVOs. Patients with MeVOs (and more distal occlusions) remain a target for finding...
When do you refer a patient with recurrent glioma for reoperation?
This question is a nuanced one that is dependent on many factors. When a patient has a recurrent glioma, the treatment options are generally re-resection, medical therapy (traditional chemotherapy or targeted agents, depending on the tumor), or radiation. Which treatment modality, or combination of ...
How do you approach the treatment of idiopathic myorhythmia?
Idiopathic myorhythmia does not always need treatment. If it is disabling, then symptomatic treatment can be offered with caution that it is not very effective. However, trying benzodiazepines, antiepileptics, and even dopaminergic medications may be useful.
What is a reasonable length of time to wait before performing a cardiac ablation for atrial fibrillation in a patient with an embolic stroke?
There is no data related to this question. If the deficits related to the stroke are mild to moderate, I would consider doing an ablation within a few weeks after an embolic stroke. With more severe deficits, I would wait longer.
What is your approach to the evaluation of minipolymyoclonus?
The term minipolymyoclonus usually describes low-amplitude arrhythmic movements of the fingers seen when the arms are outstretched, which can be seen in several conditions. The evaluation would depend on the accompanying symptoms. For example, if minipolymyoclonus is seen in the setting of weakness ...
What is the role of inpatient psychiatric or psychological evaluation in patients who have had acute function change as an inpatient?
This is an important question. An acute change in function is a frequent reason for hospital admission and must be considered as a feature of some underlying medical, neurological, or psychiatric condition. It is important to know what functions have changed, including basic and instrumental activit...
How do you treat a mild basilar artery occlusion stroke?
I agree with the prior post and would like to add some additional insight from the interventional lens. As mentioned, NIHSS isn’t well-suited to posterior circulation strokes. From the intervention side, basilar occlusion can look deceptively mild on paper, but the outcomes are often anything but. I...
What would be your approach to the consideration of the use of antiamyloid monoclonal antibodies for nonamnestic Alzheimer's disease with a positive biomarker for brain amyloid pathology?
Because treatment appropriateness is based on the stage of cognitive impairment, we base our evaluation on whether the patient meets criteria for mild cognitive impairment or early-stage dementia. We do not use cognitive testing cutoffs, even in amnestic Alzheimer's disease, as staging accounts for ...
When should you suspect that palatal tremor could be a functional neurologic disorder?
The late Dr. Hallett and others have suggested that essential palatal tremor or myoclonus is largely functional, based upon the appropriate history of variability and entrainment, plus, in some cases, electrophysiologic data as well. As a general rule, functional disorders should be diagnosed based ...