Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What are your go-to options for managing ICU delirium in patients with contraindications to antipsychotics?
Evidence for Ramelteon (Yu et al., PMID 36726202)Delirium with behavioral disturbances Depakote Clonidine Propranolol, especially with TBI Non pharmacological Make sure they're closer to the nursing station. Constant re-orientation. Shades open during the day and close at night. Bring anything they ...
Do you routinely perform muscle biopsies in patients presenting with the classic symptoms of Inclusion Body Myositis along with positive CN1A antibody?
YES. There are new consensus guidelines from ENMC about the diagnosis of IBM (Lilleker et al., PMID 38522330). They define the clinical presentation of IBM as typical (age >45, progression over >12 months, long finger flexor weakness > deltoid weakness, quadriceps weakness > hip flexors), or atypica...
What is your approach to managing hallucinations in dementia?
Hallucinations in dementia can be categorized in many ways. To begin to conceptualize a management approach, it is useful to distinguish between various types of clinical presentation: pre-existing psychosis in a patient who then develops dementia; new onset psychosis in a patient with dementia; pre...
For a patient with large volume glioblastoma, what do you do if they are found to have a subdural infection in the middle of chemoRT requiring repeat surgery?
In this scenario, the patient will likely stop the daily treatments for a variable period of time that I would estimate to be measured in weeks while recuperating from surgery and receiving IV antibiotics. When cleared for radiation, I would start by doing a new Simulation using an updated MRI to ac...
What is your approach to addressing dementia-related agitation for patients living at home with family?
There is absolutely no simple way to answer that question. Even when the family is providing a very calm and nonconfrontational environment, avoiding any possible way of causing the agitation, it is virtually impossible to predict when and why a person with dementia would become agitated, angry, unp...
How long would you stop standard GBM radiotherapy if the patient had a fall with minor head trauma?
I would do everything possible to minimize or ideally avoid treatment breaks, given no intracranial bleed. I would evaluate skin dose over the area of laceration and consider adapting the plan to meet skin constraints or lower dose to the suture if possible and not already low. If significant swelli...
Do you add antiplatelet medications to patients already on anticoagulation for atrial fibrillation if they have a stroke due to a competing etiology?
Adding antiplatelet therapy to anticoagulation in patients with atrial fibrillation and a noncardioembolic stroke has not shown a clear benefit and definitely increases bleeding risk. Okazaki et al., PMID 41051787 did not find a benefit and increased bleeding risk. An exception might be in acute MI ...
How do you approach treatment of suspected CNS vasculitis with a negative work up?
Suspected CNS vasculitis is, simply put, extremely challenging, most often because the diagnosis is difficult to make. Commonly, the diagnosis is suspected based upon non-invasive imaging showing an unusual distribution of infarcts and/or evidence of intracranial arteriopathy (CTA or formal DSA). I ...
Should ASPECTS be used to determine eligiblity for thrombolysis beyond 4.5 hours?
You can use CT and CTA (often mCTA) to decide to thrombolyse beyond 4.5h. You do not necessarily require CTP. Both cohort studies and at least two randomized trials have reported benefit from this approach. ASPECTS is a measurement scale dependent on the quality of the NCCT imaging, the quality and ...
How has the utilization of of mobile stroke units changed the landscape of in-hospital stroke management?
Mobile stroke units shift CT-based diagnosis, thrombolysis, and LVO triage into the prehospital setting, enabling earlier hospital activation and direct-to-angiography workflows. In BEST-MSU, onset-to-thrombolysis fell from 108 to 72 minutes, treatment rates rose from 79.5% to 97.1%, and 90-day mRS ...