Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you dose gabapentin in patients with renal failure?
There are many algorithms available online about the renal dosing of gabapentin. However, it should be emphasized that the recommendations are not based on large patient studies; therefore, the efficacy of the reduced doses for neuropathic pain is not certain (Raouf et al., PMID 28184168).
Do you ever start a ketogenic diet in patients who present with status epilepticus admitted to the ICU?
A ketogenic diet can be considered in super-refractory status epilepticus. There are a handful of small studies and case series that are mostly pediatric, but also a few adult papers (Camões et al., PMID 35081248, Katz et al., PMID 33671485, and Cai et al., Acta Epileptologica 2022), which suggest t...
How frequently do you check lab work in patients with stable myasthenia gravis?
It depends on what medications they are on! If patients are on pyridostigmine only (some mild ocular MG cases), none. If patients are on monotherapy with eculizumab or ravulizumab, I check none. On steroids: at least twice a year A1c, BMP, annual DEXA scan for osteoporosis, annual eye exam. On azat...
When do you consider genetic testing in patients with suspected hereditary brachial plexopathy?
There are two hereditary disorders associated with brachial plexopathy: 1) Hereditary neuralgic amyotrophy (HNA), which is caused by SEPT9 mutations ~70% of cases, and 2) Hereditary neuropathy with liability to pressure palsies (HNPP), which can manifest as a painless brachial plexopathy especially ...
When is the best time to consider left atrial appendage closure for secondary stroke prevention in patients with atrial fibrillation?
There is equipoise about the timing of left atrial appendage closure following ischemic stroke. Due to the need to temporarily treat a patient with either dual antiplatelet or anticoagulation therapy, it is reasonable to wait until after the acute stroke period has passed to allow for healing of inf...
How significant are the cardiovascular side effects, such as hypertension, associated with valproate?
I do not routinely think of cardiovascular side effects, especially HTN, as being a major factor with valproate. I think of things like cardiac conduction changes are associated with sodium channel blockers much more frequently, such as lacosamide.However, as a result of this question, I found this ...
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.