Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What is your approach to monitoring the neurologic status of a patient with a traumatic brain injury requiring burst suppression for status epilepticus?
As with any other patient in status epilepticus requiring burst suppression, the neurological exam becomes limited to pupillary light reactivity. Pharmacotherapy used in the management of status epilepticus does not negate pupillary response. Not being able to obtain frequent neurological exams on a...
How do you use cardiac biomarkers, if at all, in prognostication for patients with ischemic stroke?
For those rare patients now out 5 years post GBM treatment and continuous Optune, is there a point one would stop Optune?
I haven’t seen any data from Optune on these very long term survivors. They have released some subset data that patients who used the device 90% of the time or greater had a 29% chance of being alive at 5 years which is pretty remarkable. Certainly think there are diminishing returns beyond 5 years....
How do you approach the management of a patient with lumbar spinal metastasis with neurologic symptoms but without evidence of spinal cord compression?
From the brief description included, it appears that the lesion is at the level of the cauda equina, a group of nerves and nerve roots stemming from the distal end of the spinal cord, typically levels of L1-L5, and contains axons of nerves that give both motor and sensory innervation to the legs, bl...
What criteria do you use to decide whether to start anticonvulsants in patients with brain metastases?
Patients with intact brain metastases in the absence of seizure activity should generally not be receiving prophylactic anticonvulsants based on 2019 guidelines from the Congress of Neurologic Surgeons subsequently endorsed by SNO and ASCO. The practice of prophylactic AEDs in the post-op setting is...
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...