Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What is your strategy for treating headaches in patients with history of brain tumor?
Not all headaches in patients with brain tumors arise in the context of elevated ICP, but there are other mechanisms (dural irritation, traction on blood vessels, post-craniotomy pain, for example) by which they can be related. If the headache otherwise seems migrainous, I would treat it as migraine...
How do you manage incidentally identified pituitary lesions on brain imaging?
Pituitary lesions are among the most common incidentalomas seen on brain MRIs. Various studies cite numbers as high as 10- >30% for pituitary lesions found incidentally on brain imaging, with the higher incidence rates emerging in the era of high-resolution MRIs. In pediatric neurology/neuro-oncolog...
Do you think that home INR monitoring is a feasible option for elderly, frail patients with atrial fibrillation on VKA treatment, given variations in socioeconomic status and access to care?
Whenever possible, I prescribe home INR monitoring with appropriate equipment. This allows me to monitor my patients on a weekly basis, rather than on a monthly basis at best. Unfortunately, insurance reimbursement is not standard for this equipment, and many patients are unable to obtain it. The ab...
How do you interpret CSF pleocytosis in the context of significant leukocytosis on CBC?
There is no correction factor as there would be for CSF vs serum glucose, for example. A patient with leukocytosis in peripheral blood, for example, due to urosepsis would not always have elevated CSF WBC unless there were concomitant meningoencephalitis. I would consider 100 WBC abnormal for CSF re...
How do you evaluate a patient with MGUS and peripheral neuropathy?
When I see a patient with MGUS and peripheral neuropathy, I think about it in stages: Does the patient have an IgM-monoclonal gammopathy? If so, then I think about DADS-M. An EMG/NCS, anti-MAG antibody, PET scan, and bone marrow biopsy are generally all part of the workup. I try to do MYD88 testing...
What is your approach to patients who develop ARIA-E or ARIA-H during treatment with anti-amyloid therapies?
We follow the recommendations in the drug label that depends on the severity of each ARIA (mild/moderate/severe). Depending on the severity of ARIA, treatment may be held pending follow-up evaluation or discontinued entirely.
What is your approach to immune management in opsoclonus-myoclonus-ataxia syndrome?
I believe immunotherapy for OMAS and all neuroinflammatory diseases should always be individualized to the specific patient, ideally with input from a neuroimmunologist when possible. My practice closely follows the OMAS International Working Group consensus published in 2022 (Rossor et al., PMID 35...
Do you utilize thrombolytic therapy in patients with CRAO?
Yes. The previous trial was negative because patients with CRAO were included after 4.5 hours. There are trials underway in Europe for both tPA and TNK to address that. The retina will irreversibly infarct if the blood flow is not restored within 240 minutes (this is from basic science studies with ...
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...