Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What workup do you consider for a developmentally typical child with multiple large café au lait macules but no other signs of neurofibromatosis?
The likelihood that this is NF1 depends somewhat in part on the age of the child in question. In infants and toddlers, cafe-au-lait macules are usually the first and only clinical sign of NF1. Most children with NF1 will develop skin fold freckling in early childhood, and the majority (probably 60-7...
Would you consider using DOACs as a bridge to warfarin instead of heparin or LMWH?
I would feel very comfortable bridging with apixaban, given its relatively short half-life and fairly quick absorption. I think it is very similar to bridging with Lovenox. More importantly, it usually takes at least 24 hours until heparin IV gets to therapeutic levels - it is often too high or too ...
What holistic treatments do you recommend for patients with migraine without aura?
Before considering alternative or holistic treatments, first, assess whether both preventive and abortive treatments have been taken correctly and if there is no evidence of medication overuse. Cost and side effects often limit compliance. Lifestyle modification (which could be broadly considered as...
How do you counsel patients with mild congenital myopathy about exercise limitations?
There are many reasons why all patients with muscle disorders should exercise. Many studies have shown improvements in aerobic capacity and some have shown improvements in functional capacity (i.e., 6MWT). Furthermore, many patients with neuromuscular disorders tend to avoid exercise and this is a c...
Would you consider using IVIG for POTS in the absence of any clear autoimmune condition or abnormal antibodies?
I completely agree with the answer above. It would be a pretty rare consideration, overall. Recent placebo-controlled and blinded studies examining the efficacy of IVIG for idiopathic or antibody-associated (FGFR, TSHDS) small fiber neuropathy found no benefit of the treatment in terms of small fibe...
What type of visual disturbance qualifies as a visual aura?
Visual aura should be a time-limited neurologic event (5 minutes to 60 minutes) with or without migraine headache. It can contain positive (e.g., flashes of light) and/or negative (e.g., scotoma) visual phenomena. It is often toward one side of the visual field but is binocular (comes from both eyes...
Do you typically obtain an EEG in patients undergoing workup for cognitive dysfunction?
I do not obtain an EEG unless something in the patient's history leads me to suspect seizures.
What leads you to consider prescribing a nasal spray formulation for the treatment of acute migraine?
Interesting discussion. From my perspective, one of the big choices in the acute treatment of migraine is whether to give an oral or non-oral treatment. Patient preference studies show that oral agents are preferred if they work so I usually start there. Most patients prefer nasal sprays to subcutan...
Would you recommend TNK or DAPT in patients with stroke-like symptoms and NIHSS less than 5 presenting within 4.5 hours?
I agree with Dr. @Dr. First Last. The decision in patients with minor stroke rests on whether the symptoms are disabling, which in general, is based on a discussion with the patient and their family to understand how the deficit could impact the patient's career or hobbies. For disabling deficit, I ...
In what clinical settings is acute ICH clot removal recommended?
Clot removal should be performed when there is a cerebellar hemorrhage with brainstem compression and/or hydrocephalus. Clot removal can be considered as a life saving measure if there is neurologic deterioration, midline shift, or depressed consciousness. There is still uncertainty about clot remov...