Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
When do you consider ketamine to treat nonconvulsive status epilepticus?
Ketamine is a fine agent for the management of status epilepticus (SE) and some centers use it first line instead of propofol or midazolam. Mechanistically, it makes more sense as it controls the seizures through NMDA blockade, bypassing GABA receptors, which are downregulated in the setting of SE. ...
In a patient with acute stroke/ICH/SDH/hyperammonemia at risk for rebound edema with new onset renal failure, do you prefer CRRT versus low and slow HD?
In the acute period (first 72-96 hours after ictus), my personal preference is CRRT due to the theoretical advantage of hourly titration of ultrafiltrate. I don't know if it really matters though. As for the frequency of laboratory evaluations, I don't find more frequent than q4 hours to be useful, ...
How do you treat anti-HMGCoA myopathy?
IVIg is a great treatment for anti-HMGCoA antibody necrotizing myopathy. However, traditional treatments like methotrexate, azathioprine, as well as rituximab can be tried. We published a paper on IVIG results on refractory HMGCR and SRP positive patients with excellent results. Kocoloski et al., PM...
When is brain biopsy useful/warranted as part of the diagnostic work-up in patients with suspected primary CNS angiitis?
I have never diagnosed or seen a patient with primary angiitis of the CNS. First, I would ensure that the suspected diagnosis and findings are confined to the CNS and are not associated with a systemic inflammatory disease. If the condition is not confined to the CNS, other areas of the body may be ...
What treatment strategies do you employ in patients with Huntington's disease who have parkinsonian features?
Many HD patients actually have clinically detectable parkinsonism, but it is often masked by other more disabling problems including chorea and psychiatric symptoms. Thus, the use of traditional antiparkinsonian therapies can be hampered by substantial side effects. If a patient is not on any medica...
What is your approach to helping parents manage sleep disturbances in patients with autism spectrum disorder?
At our center, we start with sleep hygiene education, using tools such as the Autism Speaks sleep toolkit which has a printable PDF that is free for parental and clinical use. We also try to do therapy on sleep hygiene and our therapists will often try to find out what factors may exist in the home ...
When do you send AChR+ ocular myasthenia gravis patients for thymectomy?
Patients with ocular myasthenia gravis and thymoma should be referred for thymectomy. The data regarding thymectomy in non-thymomatous ocular myasthenia is more limited; thymectomy can be considered in patients who cannot tolerate, or have refractory symptoms despite, immunosuppressive therapy when ...
Is it reasonable to delay radiation therapy following surgical decompression for a patient with spinal cord compression if systemic therapy must be started as soon as possible?
I think it's unwise to delay RT for the usual solid tumor. 1) Surgical decompression seldom removes much tumor. 2) Most of these pts have already received significant chemo decreasing the chances of a meaningful response. 3) A rapid hypofractionated course of RT can usually be given resulting in onl...
What are the differential and workup for a patient with findings suggestive of idiopathic intracranial hypertension without papilledema on examination?
I agree with Dr. @Dr. First Last, and find it less difficult to "justify" a lumbar puncture than Dr. @Dr. First Last, although admittedly very sympathetic to his approach. I would perform an LP. Lumbar puncture is a very low-risk procedure and in this setting, it isn't all about visual loss, althoug...
Do you use dual anti-platelet therapy inpatients with low NIHSS who have had bilateral brainstem strokes?
I usually look at the stroke mechanism in making my decisions about DAPT rather than just relying on the NIHSS alone. If the mechanism is ICAD, branch atherosclerotic disease, SVD (with infarct extension), embolism from the aortic arch plaque, subclavian artery heterogenous plaque, extra-cranial ver...