Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
When do you restart antiplatelet therapy in patients with hemorrhagic conversion of stroke?
This is a great question and not an uncommon clinical encounter for stroke neurologists. Indeed there is no one right answer. First, you may want to make sure that the observed ICH is true transformation of an ischemic lesion. Second, the degree of hemorrhagic transformation matters, I totally agree...
When do you incorporate Lyrica into the treatment strategy for patients with restless leg syndrome?
When it comes to treating RLS, my go-to medication is gabapentin. I rarely (and possibly could say never) prescribe dopamine agonists. Once you've treated one patient with augmentation and have seen the overwhelming discomfort it can cause a patient, you would likely feel how I feel about the dopami...
What preventive medications do you recommend for patients with cluster headaches?
As per the 2016 AHS guidelines, here are the recommended treatments for cluster headache prevention: Level A: Suboccipital steroid injection Level B: Civamide 0.025% 100 uL nasal spray daily Level C: Verapamil 360 mg, Lithium 900 mg, and warfarin (INR goal 1.5-1.9, reserved for refractory patients),...
Would you consider endovascular thrombectomy for acute stroke patients with large vessel occlusion (non-large core) but with poor functional baseline with mRS 3-4?
The Modified Rankin Scale (mRS) is a widely used tool for assessing functional status, ranging from 0 (no symptoms) to 6 (death). It provides a standardized framework for EVT decision-making based on a patient’s functional status and serves as a key criterion in EVT-related RCTs. While invaluable in...
How would you manage a new suspected brain metastasis in a patient with a distant cancer history?
So I think there are some details missing but generally, if there is a suspected brain metastases in a patient with distance cancer history and that biopsy/resection is not feasible, I would consider additional workup including extracranial imaging. If the suspected brain metastases is asymptomatic ...
What is your strategy for treating headaches in patients with history of brain tumor?
Not all headaches in patients with brain tumors arise in the context of elevated ICP, but there are other mechanisms (dural irritation, traction on blood vessels, post-craniotomy pain, for example) by which they can be related. If the headache otherwise seems migrainous, I would treat it as migraine...
How do you manage incidentally identified pituitary lesions on brain imaging?
Pituitary lesions are among the most common incidentalomas seen on brain MRIs. Various studies cite numbers as high as 10- >30% for pituitary lesions found incidentally on brain imaging, with the higher incidence rates emerging in the era of high-resolution MRIs. In pediatric neurology/neuro-oncolog...
Do you think that home INR monitoring is a feasible option for elderly, frail patients with atrial fibrillation on VKA treatment, given variations in socioeconomic status and access to care?
Whenever possible, I prescribe home INR monitoring with appropriate equipment. This allows me to monitor my patients on a weekly basis, rather than on a monthly basis at best. Unfortunately, insurance reimbursement is not standard for this equipment, and many patients are unable to obtain it. The ab...
How do you interpret CSF pleocytosis in the context of significant leukocytosis on CBC?
There is no correction factor as there would be for CSF vs serum glucose, for example. A patient with leukocytosis in peripheral blood, for example, due to urosepsis would not always have elevated CSF WBC unless there were concomitant meningoencephalitis. I would consider 100 WBC abnormal for CSF re...
How do you evaluate a patient with MGUS and peripheral neuropathy?
When I see a patient with MGUS and peripheral neuropathy, I think about it in stages: Does the patient have an IgM-monoclonal gammopathy? If so, then I think about DADS-M. An EMG/NCS, anti-MAG antibody, PET scan, and bone marrow biopsy are generally all part of the workup. I try to do MYD88 testing...