Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you manage a patient with inclusion body myositis?
IBM is a slowly progressive disease with no proven treatment to date, unfortunately. The goals of care are to delay decline and maintain remaining muscle strength. The cornerstone of treatment is physical/occupational therapy. Blood flow restriction seems to anecdotally help some patients, pending t...
How would you best evaluate and manage a patient with hemiplegic migraine and a history of ischemic stroke?
Without further information, I would say that these two conditions, hemiplegic migraine and ischemic stroke, have nothing to do with each other. Hemiplegic migraine should be evaluated and managed as migraine with gepants ideal for abortive treatment and CGRP antibodies for preventive treatment if n...
Do you see a current or future clinical role of neurofilament light chain in the diagnosis or workup of multiple sclerosis?
I see the neurofilament light chain as a helpful tool for future MS monitoring. I don't believe it has a role in the initial diagnosis, as CNS damage generally causes elevations. However, research is exploring its prognostic potential for aggressive or highly active disease during the initial work-u...
What prompts you to consider prescribing different formulations of benzodiazepines for a seizure rescue medication?
I take care of adults with epilepsy, so I can't speak to the pediatric population well. For patients, with prolonged GTCs or clusters of seizures and who were previously prescribed rectal diazepam, I have transitioned many of them to nasal rescue medications with good effect and feedback from caregi...
How frequently, and in which situations do you use quantitative EEG for the detection and/or monitoring of delayed cerebral ischemia after aneurysmal SAH?
Almost never.
At what point should aspirin therapy for stable cardiovascular disease be discontinued in patients with a diagnosis of chronic cerebral microbleeds or possible Cerebral Amyloid Angiopathy?
I would continue low aspirin indefinitely.
How do you counsel patients on the outcomes of endovascular treatment of acute basilar artery occlusion?
I take a multidisciplinary approach towards counseling patients and their families about outcomes of endovascular treatment of acute basilar artery occlusion with the help of my interventional colleagues. We discuss with them the gravity of acute basilar artery occlusion (with disabling deficits) an...
What is the importance of finding a positive titer for TS-HDS and what treatment would be advised for these patients?
TS-HDS antibodies were first described by investigators from Washington University in St. Louis (2003) in five patients with painful sensory axonal neuropathy [1]. Further studies by the same group indicated that TS-HDS antibodies were associated with prominent neuropathic pain in the upper extremit...
How do you manage a glioblastoma of the brainstem/upper cervical spinal cord?
It used to be that we didn’t get biopsies in this location, and we treated suspected astrocytic tumors in the brainstem/upper spinal cord to 54 Gy in 30 fractions without tissue. The outcome was never good. But now we generally have at least a stereotactic biopsy. The outcome is still not good of co...
Would you recommend dual antiplatelet therapy or anticoagulation for a patient previously on aspirin who has a breakthrough stroke with history of CADASIL?
CADASIL is a genetic condition with a presumed mechanism of vascular injury to be disruption of the blood-brain barrier and non-atherosclerotic angiopathy. Thus, it makes sense that no anti-thrombotic has been show to reduce stroke risk. It's expert consensus to do daily aspirin, but this is more to...