Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
In what clinical scenarios do you utilize post-cardiac arrest targeted temperature management (TTM)?
There still is a role for TTM in post-cardiac arrest patients. The Targeted Temperature Management After Cardiac Arrest: A Systematic Review was a systematic review of six randomized clinical trials with a total of 3870 participants that were examined. Of these, 2,767 participants were treated with ...
How do you determine timing and frequency of stability scans for a patient with spontaneous, non-aneurysmal intracerebral hemorrhage?
We typically obtain a follow-up “stability scan” about 6 hours from the index scan. The AHA guidelines do not mention a specific timeframe. Situations, where we would consider sooner repeat imaging, would be clinical deterioration (increase in NIHSS by 4 or more points or decline in GCS by 2 or more...
Which interventions have you found effective for managing sensory sensitivities in children with autism spectrum disorder?
Sensory sensitivities are very common in ASD and are listed as one of the four aspects of the core symptoms under the restricted, repetitive behaviours, interests or activities criteria of the DSM-5. Depending on the sensitivity, therapeutic interventions can be designed and implemented by occupatio...
Do you ever utilize a steroid pulse in patients who are pregnant with status migrainosus?
According to ACOG, if steroids are use oral prednisone 20mg po QID x2d or methylprednisone dosepak is preferred over dexamethasone due to lower fetal exposure. Dexamethasone could be considered even parenterally if these do not work and attack is particularly refractory. However, they recommend that...
What typical lab tests do you send off for evaluation of neuropathy?
Not too much has changed in over a decade regarding the recommendations on how we should approach initial laboratory testing in patients presenting with a neuropathy syndrome. Specifically for cases of distal symmetric polyneuropathy, the AAN practice parameter (reaffirmed in 2022) by England, et al...
How do you differentiate between functional neurologic disorder from other underlying movement disorders?
Functional movement disorder (FMD), like most movement disorders, is a clinical rule-in diagnosis based on specific diagnostic criteria and clinical features of the patient's presentation. The examination and the phenomenology of the exhibited movements are key to diagnosing FMD. Variability, distra...
Do you use triptan medications in patients with asymptomatic critical intracranial artery stenosis?
Although the triptans are selective vasoconstrictors for the cranial non-cerebral circulation, I would not use them here for medicolegal reasons. Instead, I would use a gepant for abortive migraine treatment, which I think is the abortive migraine medication of choice in patients with demonstrated c...
How does APOE4 status affect your clinical decision-making in patients who may be eligible for anti-amyloid therapies for early Alzheimer's disease?
Studies of anti-amyloid therapies show an increased risk of ARIA, both inflammation and bleeding, in patients homozygous for APOE4. This risk is too high to justify the small benefit of these therapies in slowing cognitive deterioration.
Do you ever use ocular ultrasound in evaluation of papilledema?
As a neuro-ophthalmologist, I never use ultrasound to make a diagnosis of papilledema. I do use it to reveal optic nerve head drusen that also cause axoplasmic flow stasis and can mimic papilledema. A high quality set of fundus photos is very useful for determining the presence of optic disc edema.
Do you recommend CT perfusion in patients presenting with symptoms of acute stroke before 6 hours?
Routine CTP is not required in the <6 hours according to the AHA/ASA guidelines. The TENSION large core data would also support not requiring CTP in the early window.In the >6-24 hour period, the MR CLEAN-LATE trial, which was based on patients with CTA collaterals selection, showed favorable outcom...