Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What is the preferred approach to managing non-occlusive or partially occlusive venous sinus thrombosis?
I would recommend a DOAC, particularly apixaban, with follow-up imaging in 3 months.
Is vaginal delivery safe in patients diagnosed with pseudotumor cerebri (IIH)?
This is a challenging situation. Unfortunately, both acetazolamide and topiramate are relatively contraindicated due to potential teratogenicity. Probably the most effective treatment is weight loss, just like with non-pregnant patients. However, this is easier said than done, especially in pregnanc...
Beyond fatigability, what distinctive features of diplopia characterize myasthenia gravis?
The key to ocular myasthenia is variability- maybe more than fatigue. If the diplopia is always in the same direction and even more clearly stemming from one eye (and muscle) then this is more likely to be an isolated muscle weakness- whether from nerve disorder or latent strabismus. But if the dipl...
How do you manage immunotherapy-induced myasthenia gravis?
My go-to algorithm is well-represented in the paper by Dr. @Dr. First Last et al. Zubair et al., PMID 36439604
What is your workup and treatment approach for cranial neuropathies in patients with lupus?
Pretty much the same as is done for SLE patients presenting with acute or chronic inflammatory peripheral neuropathies with the additional concern for leptomeningeal inflammation. Evaluation: Cranial MR, CSF studies (cell count, albumin, IgG level with accompanying serum levels to determine IgG Inde...
Which method do you prefer to assess for stigmata of old optic neuropathy?
If I'm not convinced based on my history and exam, I will typically refer to ophthalmology and at our institution, they tend to gravitate towards OCT rather than VEPs. There are a number of findings on examination to complement the history, including afferent pupillary response to light, errors on i...
Is a history of coronary artery disease and afib a contraindication to using donepezil?
No.
How would one approach treating a patient with primary immunodeficiency on IVIG treatment who develops myasthenia gravis?
Sounds like an interesting case. More information relating to MG will help discuss treatment options, such as the patient's age, other comorbidity, antibody status, thymus status, etc.
What is the clinical utility of getting repeat antibody testing in patients with recurrent symptoms and a history of Miller-Fischer syndrome?
The treatment of MFS is controversial and not addressed in the recently published guidelines. Should a patient exhibit muscle weakness beyond facial and EOM, it could imply an overlap between MFS and/or GBS. While there's limited study in this area, persistent antibodies, albeit reduced, might not s...
Is there a concern for the potential of future congenital malformations in offspring when preservation of eggs and sperm is done AFTER cyclophosphamide treatment given that it is an alkylating agent?
No, there is not a significant risk of congenital malformations in embryos created with cryopreserved gametes or unassisted pregnancies AFTER cyclophosphamide use. While alkylating agents lead to both male and female infertility, congenital malformations from cyclophosphamide occur when conception h...