Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you time CSF analysis for suspected CNS lymphoma in patients who are on steroids?
As soon as possible. The diagnostic yield of biopsy or LP can diminish very quickly after steroid initiation. Holding steroids for 7-10 days if possible is one common strategy to try to mitigate this. If steroids are unavoidable, or if tapering/holding them is not feasible, additional strategies to ...
When is the best time to try targeted therapy in adult-type diffuse non-IDH glioma?
Has this practice changed since posted?
Does TpA or TNK cause acute post infusion severe headache with no intracranial bleed?
The short answer is yes patients can develop headaches post thrombolysis. Some report about 32-33% of AIS patients post thrombolysis experience headaches without hemorrhagic conversion. These do not seem to be associated with the increasing risk of hemorrhagic conversion. Some stroke patients develo...
How long do oscillopsia and ataxia secondary to thiamine deficiency last after completing repletion?
I treated a patient with severe thiamine deficiency following bariatric surgery. I administered parenteral thiamine at a dose of 100 mg weekly. The diplopia resolved with the first infusion, but returned 5-6 days. She was continued on thiamine infusions weekly and her diplopia eventually resolved. I...
In patients being evaluated for brain death, which abnormal movements are definitively known to still be consistent with brain death and which are possibly consistent with brain death but lack definitive evidence?
This is indeed a challenging question, one that I continue to grapple with as a neurointensivist. Fortunately, most brain-dead patients do not exhibit any movements in response to noxious stimuli, but some case series report reflexive movement in up to 75% of cases. The classic teaching is that only...
How do you medically manage acute basilar artery occlusion in patients with low NIHSS who are not candidates for EVT but at risk for deterioration?
First, I would consider endovascular therapy even with a low NIHSS, if the patient is otherwise a good candidate. If this were not possible, I would angicoagulate with IV heparin initially, then a DOAC (direct oral anticoagulant).
When would you refer patients with Parsonage-Turner syndrome for surgical treatment?
An introduction is required because this is a relatively new concept in the management of neuralgic amyotrophy.Despite historical data from the '90s suggesting that >80% of Parsonage-Turner (neuralgic amyotrophy/NA) patients will show significant improvement of motor function in two years after the ...
How do you manage AEDs in patients with malignant brain tumors?
Use of prophylactic anti-seizure drugs in patients with primary malignant brain tumors is not recommended and has been evaluated in multiple systematic reviews and guidelines including a recent systematic review and well-done guideline paper from SNO and EANO published by Tobias Walbert, Elizabeth G...
What is your approach to the treatment of idiopathic intracranial hypertension with transverse sinus stenosis?
I don't know of a way to determine whether the venous stenosis is the cause. It's a common finding in intracranial hypertension and unclear whether it is the cause or effect of intracranial hypertension. If the patient is not having vision deterioration and can be managed with medication and weight ...
How does premorbid dementia affect your decision to offer acute stroke intervention?
Receiving a report on an acute stroke patient with "dementia" often feels like an umbrella term and, in my experience, tends to serve more as a label than an accurate reflection of their baseline cognitive function. Ideally, having enough clinical information to classify cognitive impairment as mild...