Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Which non-pharmacologic treatments for neuropathic pain have you found most effective?
There is data supporting a positive role for lifestyle changes, primarily physical exercise, suggesting that consistent engagement can reduce neuropathic pain. They included aerobic, resistance, and balance programs for anti-sedentary behavior.
Is the p-tau217 plasma test used as a surrogate for amyloid PET scan or CSF testing when considering starting Leqembi in patients with Alzheimer's disease?
P-tau127 is an excellent surrogate for amyloid, though it is not yet standard practice. Currently, there are no best practice guidelines on whether p-tau217 alone is sufficient or if it needs to be combined with Aβ42/Aβ40 or APOE4. These are available clinically but not yet FDA-approved. The FDA-app...
When do you consider thrombectomy for patients with LVO and carotid dissection?
In most situations, unless there is no deficit, NCCT shows ICH, or CTP shows no significant penumbra. Dissection in itself is not a contraindication to thrombectomy.
Would a longstanding diagnosis of multiple sclerosis impact your radiation recommendations for a patient with breast cancer?
In my opinion, the simple answer is no. At least not in my experience treating one MS patient with whole breast radiation. Unlike Scleroderma, which is an autoimmune disease that can result in inflammation and thickening of the skin, connective tissues, and internal organs, MS is an autoimmune disea...
Can anti-cardiolipin or anti-beta-2 glycoprotein antibodies cause prolonged PTT in the absence of a lupus anticoagulant?
Lupus anticoagulants are a heterogeneous group of antibodies that do not have uniform activity in all assays. Furthermore, testing procedures are not well-standardized. Since relevant clotting factor deficiencies have been ruled out and the long PTT does not correct with mixing, and since there is o...
What is your preferred site for central venous access in patients with concern for raised intracranial pressures?
Subclavian is our preferred central venous access for raised ICP, but we also utilize femoral lines for patients at high risk of pneumothorax or who need more emergent access. We have historically avoided IJ lines because of concern for impeding venous drainage by blocking the IJ. I do not think thi...
What markers on EEG can help predict/detect postoperative or ICU-related delirium?
The interest in the use of EEG for delirium prediction/detection has increased in recent years. Postoperative delirium (POD) is common and is linked to adverse long-term cognitive outcomes. Preoperative EEG biomarkers of postoperative delirium may aid in risk stratification and implementation of pre...
What are some methods you use to limit or decrease the development of post-ICU PTSD in patients?
The following strategies are employed: While in ICU: For a patient who is intubated and sedated --> limiting sedation, promoting nighttime sleep (with NAP protocols, sleep aids etc.), addressing delirium and pain, (sleep wake cycles, minimizing narcotics and benzodiazepines, etc.), maintaining awake...
How does your decision to use high-efficacy disease-modifying treatments (HET) differ, if at all, when treating late-onset relapsing-remitting multiple sclerosis?
For late-onset patients who still have evidence of active disease (gad-enhancing lesions on MRI within the past 1-2 years), I will treat with HET, such as anti-CD20 therapy. Older individuals tend to have less ability to fully recover post-relapses than younger persons. I would be more hesitant to u...
How many times one can use IVIG in GBS?
There is currently no evidence supporting the efficacy of a second dose of IVIg or the addition of IVIg after PLEX in GBS. Clinical trials investigating complement inhibitors in GBS are ongoing, although conclusive results are pending. Encouraging results have emerged from a small Japanese study. Co...