Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What considerations should you discuss with patients prior to genetic testing for suspected Huntington disease?
Genetic testing for Huntington disease (HD) is dependent on several factors, including age, family planning, and the genetics of family members known to have the disease. For example, if someone in the family has a known mutation in the HTT gene, and the individual you are assessing has signs of HD,...
When do you check neurofilament light chain in patients with neurodegenerative illnesses?
Neurofilament light chain polypeptide is a protein that can be released in blood or CSF during (active) injury to nerve axons in the CNS. Until recently, this was exclusively a research tool, and in the last 5-6 years we saw an explosion of publications, demonstrating the utility of this biomarker, ...
How do you use total IgG levels, if at all, to guide plasma exchange for myasthenia gravis exacerbations?
I do not routinely measure total IgG levels before the first and after the last session of PLEX in MG exacerbations, and I do not use this lab to determine the number of required PLEX sessions, but I understand the rationale of the question, and I believe that this topic requires further study. I on...
When do you use MRI to further evaluate patients with non-traumatic subdural hemorrhage?
No, I do not.
When do you consider attributing isolated psychosis to an acute ischemic stroke?
Though relatively rare, systematic reviews have found post-stroke psychosis to occur in just under 5% of patients. When considering attributing psychosis to an acute stroke, there are several things it can be helpful to consider: Differential diagnosis: Making sure to rule out more common etio...
How does the mechanism of trauma in post-traumatic headache influence counseling of patients and their families?
If I understand the question correctly, the mechanism of PTH is important in the sense that it is needed for the diagnosis. After establishing that there was a trauma responsible for the phenotype and headache characteristics of the patient, counseling of patients and families may include screening ...
What are red flags in an evaluation for possible multiple sclerosis that should prompt workup for genetic/inherited conditions?
Clinical red flags: Chronic, progressive course, developmental regression preceding presenting event, positive family history of similar symptoms, other organ involvement such as diabetes, sensorineural hearing loss, cardiomyopathy, GI dysmotility, rapid bilateral vision loss without other evidence ...
When is a paraneoplastic panel indicated when working up patients with neuromuscular conditions?
Is there any benefit from oral vs topical steroids in herpes zoster opthalmicus?
The role of steroids in uncomplicated herpes zoster is limited, but weak evidence suggests they may provide some symptomatic relief. However, oral and topical steroids may have a role in complicated zoster, including cases with ocular involvement/HZO, when used with antiviral therapy, especially if ...
How does the presence of signs of cerebral edema influence your decision for thrombolysis and endovascular thrombectomy?
When deciding on intervention for large core strokes, the presence of cerebral edema is something I expect rather than a factor that would change my approach. The article examined net water uptake (NWU) as a potential imaging marker to predict edema progression in large core stroke. While the second...