Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you decide between using an intracranial pressure monitor (bolt) versus an extraventricular drain (EVD) for intracranial pressure monitoring in cases of diffuse cerebral injury?
I think the decision about whether to place an external ventricular drain (EVD) or an intraparenchymal ICP monitor (IPM) rests on many factors, including:1) Need for CSF drainage - if the patient has hydrocephalus or CSF drainage is anticipated to be useful in controlling ICP, then an EVD is prefera...
When do you consider testing with stroke gene panels in young stroke patients?
Broadly, I ask for genetic testing only when I have a specific diagnosis in mind. This testing is not routine in my practice. Examples are: A patient is referred for white matter lesions found on brain MR and a transient neurological episode. The question of CADASIL(NOTCH-3) or related disorders is...
What prompts you to procure EEG and/or imaging in patients presenting with multiple simple febrile seizures?
History always plays a key role. Is the child developing normally, and how old is the child? Also, were all of the seizures truly simple, or were there other features that make me suspicious that this is actually a "lower seizure threshold" in a patient with underlying epilepsy? Fortunately, a sleep...
How do you manage stroke-related abulia?
There is surprisingly little recent evidence-based guidance on this front. Most therapeutic options focus on agonism or potentiation of dopamine in the frontal-subcortical circuits. Depending on the center and provider, options include psychostimulants. Any type might do but I prefer methylphenidate...
Do you recommend pre-emptive anti-epileptic treatment for patients with spontaneous ICH?
This question also applies to other scenarios such as ischemic stroke, brain tumors, and TBI. Many neurologists do not, but neurosurgeons often do. The evidence for this is very limited, so a reasonable answer is as follows. 1) Yes, if an EEG shows epileptiform discharges. 2) Evidence or not, modern...
How do you counsel patients and caregivers on dietary interventions for autism?
Whole foods diet, e.g., Whole30.com. All the information on that website is free. I will remove common food allergens. Remove all synthetic food dyes. 100% organic to protect the microbiome. Consider a spore-based probiotic for a few months.
What are outpatient strategies to mitigate taxane-induced peripheral neuropathy?
At the present time, there are no established means for preventing taxane-induced neuropathy other than limiting the dose that is given. In patients who are receiving taxane therapy and have developed significant neuropathy, ASCO guidelines suggest that discussion should be had with patients with re...
Do you test for genetic ataxias prior to making a diagnosis of cerebellar-type Multiple System Atrophy?
It depends. If there is no family history of ataxia, neuropathy, significant dysautonomia, or RBD, then I do not. I might consider getting a DaT scan or Synone skin testing to further reinforce the diagnosis of MSA-C (knowing that a DaT scan may be negative here, too). If, on the other hand, there i...
Do all patients referred for acute symptoms of TIA or minor stroke require additional imaging with CT/MR angiography, in addition to admission/observation?
Regardless of whether symptoms are minor, improve, or resolve, it is important to obtain vessel imaging to evaluate the underlying head and neck vasculature, as this may guide additional treatments (e.g., carotid revascularization, ICAD management, dissection management, carotid-web management, etc....
Will you do Botox or use injectable CGRP monoclonal antibodies in patients on anticoagulation?
I use Botox and injectable CGRP monoclonal antibodies in patients on anticoagulation. I do not check INR prior to using Botox if patients are on AC. I have been practicing headache medicine since 2013 and have never noticed increased bleeding in patients on AC during a Botox procedure. The injection...