Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you approach workup and management of hyperhidrosis?
Oral anticholinergics
Do you routinely administer desmopressin to patients with intracerebral hemorrhage who are also on anti-platelet therapy?
I routinely administer desmopressin in patients presenting with ICH if they are on dual antiplatelets but not single antiplatelets. The evidence for this is limited, but it has not revealed any harm.
Would you consider intravenous thrombolytics for an acute spinal ischemic stroke?
I would not use thrombolytic therapy for an acute spinal ischemic stroke. There is no good information about the benefits and risks of this therapy in this clinical situation.
When do you consider discontinuing disease modifying therapies for multiple sclerosis?
Certainly, age is increasingly being defined as a factor that influences disease evolution. There are some articles that suggest 55 years might be a 'turning point' to discontinue disease modifying therapies but my preference, particularly when there is no radiological or clinical worsening over the...
What biomarkers best predict the response to B-cell depleting therapies in MS?
I would say that checking CD19 counts is helpful to monitor response to B-cell therapy, but it is not useful in predicting response. I used to check this before and after starting B-cell therapies, but ultimately did not find it useful. I now only check it if someone has breakthrough disease activit...
What have been your experiences with anti-CGRP therapies for hemiplegic migraine?
I think it is important to point out that true hemiplegic migraine is very rare. Many patients are incorrectly diagnosed with (sporadic) hemiplegic migraine, and actually have sensory aura or *MUMS. These patients can absolutely have CGRP-targeted medications.In terms of true hemiplegic migraine, I ...
How do you approach the management of poorly controlled migraines during pregnancy?
This is an excellent question and area of frequent discussion. You can start with Lidocaine nerve blocks: occipital, supra-orbital, and temporal. Sometimes, just IV fluids will help for acute migraines. Other options include Reglan, caffeine, and APAP. If in the second trimester, I will do steroid t...
In which clinical scenarios do you find medial and lateral plantar sensory or mixed nerve conduction studies to be valuable?
I agree with Dr. @Dr. First Last. I would just add that I frequently do these when patients are complaining of numbness, paresthesias, or pain in the plantar aspect of their feet. If normal, you can be more clear about whether a large fiber neuropathy is present. If the symptoms are just in the toes...
Do you treat cerebral vein thrombosis with parenchymal hemorrhage using full dose heparin protocol rather than the high risk protocol?
I just want to clarify the question a bit. I will assume that you mean cerebral venous sinus thrombosis with cerebral vein thrombosis here. IV heparin is considered a standard treatment for cerebral venous sinus thrombus, but not necessarily cerebral vein thrombosis. Heparin for isolated cortical ve...
What is your strategy for treating persistent headaches in the aftermath of subarachnoid hemorrhage?
In the immediate aftermath of a subarachnoid hemorrhage, regardless of whether the aneurysm has been secured or not, the following strategies can be employed to manage headaches: Headache Cocktail: This may consist of magnesium infusions, Benadryl, and an antiemetic like Compazine. Magnesium infusi...