Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you complete brain death testing in patients who cannot tolerate apnea testing and are unable to transport for ancillary testing?
The short answer is that you cannot. Brain death diagnosis requires the presence of 3 conditions: persistent coma, absence of brainstem reflexes, and lack of ability to breathe independently. If portions of the clinical exam or apnea test cannot be performed, ancillary testing is necessary to make t...
Do you typically counsel patients to avoid intranasal triptan administration on same side of pain in cluster headaches?
We usually don't. But the idea is for bad clusters, intra nasal may not work anyway so IM sumatriptan may be a better option.
How would you manage a patient who develops acute stroke during neoadjuvant chemotherapy with KEYNOTE-522 for Stage III triple negative breast cancer?
I will try to provide some data for discussion, but also welcome comments from other experts and opinions. I'm assuming this is a younger patient without known risk factors and that an assessment for things like A. Fib, PFO, and DVT have been performed.Chemotherapy has long been associated with thro...
What postural change in FVC is suggestive of respiratory muscle weakness?
In our practice, an assisted ventilation clinic which is enriched with patients who have diagnosed neuromuscular disease and/or chronic respiratory failure of unclear etiology, we often use 12% or 200cc simply by analogy to the criteria we use to assess bronchodilator responsiveness during PFTs. Alt...
Would you proceed with anti-CD20 treatment in an MS patient who is VZV IgG negative in spite of vaccination in the last year?
There is no clear data on management. In my experience, if a patient has been vaccinated in the recent past, then I will proceed with anti-CD20 therapy. However, if vaccination was in the remote past, I have asked patients to repeat vaccination before initiating therapy.
What further testing do you recommend for incidentally found ependymitis granularis as part of headache workup?
I would defer this question to a neuroradiologist.
In pediatric patients with low-grade gliomas showing prolonged response or stable disease on tovorafenib, how would you adjust the duration of therapy?
This is a one-million-dollar question. As far as I know, the design of FIREFLY-2 includes a fixed duration of treatment, and this is also the case for ACSN1833 (selumetinib trial). It will be important to look at the PFS of the patients who discontinued tovorafenib and compare with the results of ch...
How often do you screen for cerebral aneurysms in patients with autosomal dominant polycystic kidney disease who do not have a family history of intracranial aneurysms or for whom the family history is unknown?
We recently wrote an editorial about this topic. Our conclusion was as follows: "considering the potential for morbidity and mortality in this unique population at risk for ICAs with possibly higher-than-average risk of rupture, we believe that presymptomatic screening for ICA in all individuals wit...
How do you treat patients with blepharospasm?
Botulinum toxin injections.
How do you treat benign fasciculation syndrome?
Reassurance. Just telling the patient that it isn’t ALS and it’s a benign and common condition will often suffice. If it doesn’t suffice: Address anxiety with psychotherapy, medications, or both. Reduce caffeine intake, and ensure the patient gets adequate sleep. If the first and second options don...