Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Which patients presenting with spontaneous ICH should be considered for a diagnostic cerebral angiogram/DSA?
Given the ease of obtaining CT angiograms, the majority of patients both with and without a history of hypertension are routinely getting CTA's. This has truly led to a minimization of the need for diagnostic cerebral angiograms. While the diagnostic performance of noninvasive neuroimaging is not cl...
How do you prescribe ketamine for treatment of refractory status epilepticus, and what is its efficacy?
For cases of RSE, I usually turn to ketamine if I encounter hypotension with propofol or if I'm not achieving the desired EEG response. My typical approach involves administering a 100 mg bolus followed by a continuous infusion of 100 mg/hr. For more detailed information, you can refer to this artic...
How do you counsel newly diagnosed patients with ALS on dietary recommendations?
I counsel all my newly diagnosed ALS patients about the importance of weight maintenance. Weight loss is an established risk factor for accelerated ALS progression according to several studies (Janse van Mantgem et al., PMID 32576612 and Jawaid et al., PMID 20500116). Therefore, we always aim to mai...
How would you approach additional workup and management of a patient with active Crohn’s disease, who has multiple lung and brain nodules, with lung pathology demonstrating necrotizing granulomatous inflammation and brain biopsy with granulomatous inflammation and medium-large vessel vasculitis?
This is a great question and a challenging case. Further workup would depend on the clinical presentation and the risk factors of this particular patient, however, I will outline some broad considerations centered around questions I would consider in a similar case. Has Crohn's disease been definit...
What work-up do you recommend in patients with early-onset dementia?
After a thorough history (especially drugs, alcohol and Family Hx) - would do: imaging study, TSH, B12 level and consider genetic labs and CSF for early onset dementia.
In what clinical situation do you use Botox in patients with increased salivation?
Botulinum toxin injections are considered first-line pharmacologic management for sialorrhea due to their safety and efficacy with appropriate patient selection. It can be considered for patients who have increased aspiration risk, skin breakdown from drooling, or experience social effects like emba...
How do you dose steroids in neurosarcoidosis patients with a worsening clinical symptoms or MRI findings?
The route of dosing of glucocorticoids for neurosarcoidosis typically depends on the severity of illness and symptoms. For example, significant CNS involvement on imaging or patients presenting with AMS, weakness, vision changes/loss, or seizures would benefit from IV methylprednisolone followed by ...
When would you consider neuro-stimulants in post-stroke patients?
To my knowledge, there are no large, randomized trials supporting the use of neurostimulants in stroke rehabilitation. When patients are too sleepy to participate in therapy, I have been known to use very low-dose methylphenidate or modafinil. Levodopa has also been tried with mixed results.
What is the practical application of serological MS disease activity testing (offered by Octave Bio) for patients with MS?
I have been using the MSDA in my clinic for about a year now. I have found it to be a reliable indicator of suspected, known, and in a few cases, impending, disease activity. When to order it and why is where I think we need to do some work. Some examples where I think it has been useful for my pati...
What was the rationale behind using RANO-HGG criteria instead of RAPNO criteria for the primary endpoint in the FIREFLY-1 trial for pLGG?
The primary endpoint for the FIREFLY-1 trial was the overall response rate using RANO-HGG because, at the time the protocol was designed, this was the only clinically validated response criteria for brain tumors. However, more recently the RAPNO-LGG criteria were published which focuses on T2 weight...