Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Is history of GBS a contraindication for all future flu vaccines?
In my opinion, the answer is no. Numerous studies have been published about this topic. Based on a recent review (see below): The additional risk for GBS attributed to influenza vaccination is 1-2 cases per million of vaccinated individuals. The risk of GBS following influenza INFECTION is several o...
How does your treatment approach differ in patients with acute visual loss due to central retinal artery occlusion versus retinal vein occlusion?
Central retinal artery occlusion (CRAO), is an embolic event in most patients, where the source can be the heart or a plaque in the aorta or internal carotid artery. A prompt workup for the source is important. Central retinal vein occlusion is more often just the result of risk factors (such as dia...
Does aspirin dose (81 mg vs 325 mg) matter for secondary stroke prevention?
This topic has been debated extensively. There are two camps in this debate: Aspirin with a dose of 81 mg is adequate for platelet inhibition in the general population. Aspirin with a dose of 325 mg may be needed for individuals who weigh more (>70 kg) to achieve appropriate platelet inhibition. T...
Would you recommend a neck soft collar after a cervical internal carotid artery dissection?
I would sincerely doubt that would have any benefit. Avoiding more strenuous or sudden trauma would be more appropriate.
Would you recommend a CT venogram or MR venogram in patients with concern for venous sinus thrombosis?
Either modality is suitable for assessing CVST. However, I typically prefer CTV. It's easier to obtain and has a quick scan time, which reduces the chances of motion artifacts. MRV provides better resolution, but it requires a screening form and has a longer scan time, which may lead to motion artif...
In a patient with presumed autoimmune encephalitis, would treating them with IVIG before getting a brain biopsy alter the pathological changes in a meaningful way?
I don't think IVIG would meaningfully alter the results of a brain biopsy. However, a biopsy is frequently less informative in diagnosing autoimmune encephalitis compared to CSF and serum autoantibody testing. It's worth noting that IVIG can trigger aseptic meningitis, so it's essential to exercise ...
How do you manage patients with embolic stroke of an undetermined source and a papillary fibroelastoma found on an echocardiogram?
The definitive treatment is surgical, and the only way of knowing for certain that the lesion is a fibroelastoma is to perform surgery and obtain pathology. If a patient is not a candidate for heart surgery, anticoagulation could be tried.
Do you typically load DAPT in patients with ICAD?
If the ICAD lesion is symptomatic and the patient is aspirin-naive, I administer a one-time loading dose of 325 mg of aspirin, followed by 81 mg after that. I do not administer a loading dose of the P2Y12-inhibiting agent (such as clopidogrel, ticagrelor, etc.). I continue DAPT for 3 months then tra...
Do you recommend any particular type of contraceptive use in young patients with strokes of unclear etiology?
The safest choice would be a progesterone-only method. If a combination must be used, the lowest estrogen option.
How do you initiate steroids in ocular Myasthenia Gravis?
It's the same with generalized MG. The only difference is that I avoid increasing the dose to more than 30-40 mg of prednisone per day (if possible). Many experts propose initiating dosing every other day, but I have never been a big fan of this regimen because I have seen several patients experienc...