Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Would you offer adjuvant radiotherapy for a gross totally resected WHO grade 2 hemangiopericytoma/MFT of the brain in a patient with active multiple sclerosis?
This is a tough question to answer, as there are risks associated with either recommending post-operative radiotherapy or not. Hemangiopericytomas are rare intracranial tumors that arise from pericytes, support cells found in the wall of meningeal capillaries. They are part of a larger spectrum of m...
For patients with newly diagnosed brain metastases without a history of seizure activity, do you routinely start anti-seizure medication?
This is a common clinical question that has been repeatedly explored in meta-analyses and clinical guidelines. Consistently, there's no evidence to support primary prophylaxis for seizures in patients with brain tumors including brain metastases. In summary, the data does not support the routine use...
Would you recommend anticoagulation in a pediatric patient with metastases in a dural venous sinus?
For an adult patient would consider if there is evidence of tumor-associated thrombus on initial imaging or follow-up, but not usually from a prophylactic perspective. This may be different in a pediatric patient and also might depend on the primary malignancy or hematologic, or neurologic comorbidi...
What are your preferred anti-seizure medications for Doose syndrome?
Meds are not listed in any necessary order: valproic acid, clobazam (any other benzo), ketogenic diet, and felbamate. The ketogenic diet and felbamate are the most effective.
How would you approach the workup of unilateral chorea with a normal MRI?
I would first rule out Sydenham chorea by checking ASO titers, DNase B titers, ESR, and CRP, and performing an echocardiogram and EKG. I would also recommend an MR angiogram if not already done for Moya-Moya. Following that, I would check copper levels, ceruloplasmin, serum amino acids, serum lactat...
Is there a role for using parenteral anticoagulation for occlusive extensive ICA thrombus with acute onset of symptoms when patients are not candidates for endovascular therapy, such as low NIHSS?
If interpreting the question correctly, it refers to an extensive/occlusive thrombus in the ICA as an acute vessel occlusion? In such cases, my decision between the medical and endovascular approaches largely depends on the segmental location of the occlusion. For a proximal cervical-segment ICA occ...
How frequently do you re-evaluate AChR and MuSK antibodies in patients with clinical and electrodiagnostic evidence of seronegative myasthenia gravis?
I usually recheck AchR binding antibodies 1-2 years after the initial negative test because some patients will “seroconvert”. I don’t recheck MuSk if the initial was negative. And one recent “secret”: the University of Oxford in the UK for years had patented the development of a cell-based assay to ...
Is there any evidence that radiotherapy can worsen balance, dizziness, or vertigo in patients treated for vestibular schwannoma due to transient edema?
While the answer from Dr. @Dr. First Last addresses a much broader category of patients treated with SRS, we have looked specifically at post radiation side effects after treatment of vestibular schwannomas treated with either SRS (12.5 Gy), hypofractionated SRS (hSRT with 5 fractions of 5 Gy), or c...
Would testing for ATTR cardiac amyloidosis be considered in an older patient with bilateral carpal tunnel surgeries and multiple spinal stenosis surgeries, but no obvious cardiac symptoms?
I would not look for ATTR-CM in the absence of cardiac findings such as abnormal echo (increased LV thickness) or conduction abnormalities that are suggestive. Only 10% of patients with bilateral CTS have ATTR-CM. I would do an echo if not done and review ECG. As much as we are concerned about under...
When do you consider repeating CSF studies in a patient with suspected viral encephalitis but overall initially unrevealing CSF?
Definitely not an expert on this topic, but this situation does come up, particularly for HSV encephalitis! One question worth asking your lab is what kind of assay are they using to run this test. If it's a dedicated HSV PCR assay (e.g., Simplexa), then the sensitivity is going to be quite robust, ...