Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What is the expected timeframe one would expect to see paroxysmal sympathetic hyperactivity/sympathetic storming persist post-traumatic brain injury?
I've personally seen as long as 30+ days but usually less.
How do you approach management of patients with lupus and transverse myelitis not responding to pulse dose steroids?
I consider TM or longitudinal myelitis an emergency. I have been pretty aggressive in my treatment with this diagnosis, and have treated a case with pulse steroids, plex, and Cytoxan with excellent outcomes. The main challenge in such situations is differentiating overlapping MS or other autoimmune ...
What recommendations would you make for a patient on long-term phenytoin due to epilepsy with a newly diagnosed breast cancer requiring doxorubicin as part of her chemotherapy?
Change to Keppra and use doxorubicin.
Do you ever use IVIG in patients with parsonage-turner syndrome?
I do not use IVIG for the treatment of parsonage turner syndrome. There are several case reports that state that patients' symptoms improved however, several of these used concomitant steroids with the IVIG. The steroids may be helpful in reducing the pain but there is little evidence that either st...
Which myositis patients are good candidates for IVIG?
Good candidates for IVIG in myositis include any patient with refractory dermatomyositis, refractory necrotizing myopathy, anti-HMGCR antibody-positive patients, as well as patients with dysphagia, pregnancy, infection or malignancy. In general, it can be added to 1st-, 2nd- or 3rd-line treatment in...
How do you approach the initiation and/or continuation of antiseizure medication in a patient who has experienced one lifetime seizure with a normal EEG and MRI with a comorbid health condition that is associated with an increased risk of epilepsy?
AAN Guideline (2015): Management of an Unprovoked First Seizure in AdultsAntiepileptic drug treatment after an unprovoked first seizure (Bao et al 2018)The 2015 AAN guidelines point to level B evidence that starting ASMs decreases the overall risk of recurrent seizure within 2 years. The Bao et al 2...
When do you consider patients with acute stroke with large vessel occlusion with very low ASPECTS scores (less than 3) for endovascular thrombectomy?
Last year was an exciting year for interventional stroke care, as several trials (RESCUE-Japan LIMIT, SELECT-2, ANGEL-ASPECT, TENSION, TESLA, and LASTE) demonstrated statistically significant or positive-signal benefits in endovascular thrombectomy (EVT) for large vessel occlusion (LVO) and large-co...
Do you routinely obtain baseline vascular imaging (CTA, MRA, PET) in patients with suspected GCA, but negative temporal artery biopsy?
Vascular imaging is particularly helpful in patients with large vessel giant cell arteritis. This patient subset may present with persistent constitutional symptoms, refractory polymyalgia rheumatica, fever of unknown origin, or with vascular signs/symptoms (for example arm claudication). These pati...
What is your approach to the management of asymptomatic intracranial atherosclerosis discovered during the workup of an acute stroke?
I would maximize the treatment of vascular risk factors such as hypertension, elevated cholesterol, and diabetes. The patient will be taking an antithrombotic medication for the acute stroke so that will also reduce the risk of stroke related to ICAD.
When do you re-image patients with a diagnosis of venous sinus thrombosis?
My practice is to perform early reimaging, typically at around 2 weeks, before transitioning from parenteral anticoagulation to oral anticoagulation. This early reassessment is important as recanalization processes begin early and are linked to clinical outcomes. Subsequent imaging at 6 months is al...