Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
When do you consider immunosuppression in patients with Sjogren's neuropathy?
Only when disease activity is moderate-severe, impairing QoL, or rapidly progressive, ie mononeuritis multiplex/vasculitis, with significant risk of end-organ/tissue damage. Occasionally, autonomic neuropathy in SjD can be so debilitating to patient, and all other supportive treatments have failed, ...
How long do you wait for a patient to be seizure-free before you clear them with regard to operating heavy machinery (i.e., for work)?
I would use the driving laws in the state where the patient resides as the guide for this. After all, if the patient can drive a car, it would be hard to tell them they can’t operate other heavy machinery. In my state, this would mean 6-12 months (we have a variable restriction on driving privileges...
How do you approach treatment of a spinal meningioma?
Surgery is usually the first option. If there is a good resection, the histology is WHO grade 1 (usually) and any residual tumor, if present, does not threaten the spinal cord, one could observe and decide on further action later when the tumor shows signs of growth. If the surgery is only a biopsy ...
What are the recommendations for considering deep brain stimulation in a patient with tremors and dementia or mild cognitive impairment?
In PD, studies with the strongest quality of evidence show a slight decline in global cognition in patients undergoing STN-DBS compared to GPi-DBS or medical therapy. However, the majority of controlled clinical trials and observational studies do not find changes in global cognition among these gro...
In patients with Afib on anticoagulation and concurrent intracranial atherosclerotic disease, would you consider adding an anti-platelet to anticoagulation if there are recurrent events that could be related to the ICAD?
This is a difficult clinical situation. If the new stroke was clearly in the vascular territory related to the ICAD, I would consider adding low-dose aspirin to the anticoagulant. I would also consider using the 2.5 mg dose of apixaban as the anticoagulant to reduce the risk of major bleeding associ...
When do you consider ambulatory EEG as a reasonable alternative to inpatient video EEG?
There are many reasons to use ambulatory EEG video, as long as it is of good quality: Daily events and no need to reduce ASMs Shorter wait time The patient cannot bring a loved one to the EMU The patient cannot be hospitalized for days The main advantages of the inpatient setting are: The ability to...
What is your approach to management of a subtotally resected pineal parenchymal tumor of intermediate differentiation (CNS WHO grade 2)?
In full disclosure, I have had only one adult patient with PPTID. Although PPTID was first described in 1993, it was not recognized by the WHO until the 2000 classification and represents only 1% of primary central nervous system tumors. Prognosis falls somewhere between that of a pineocytoma and pi...
How do you reconcile the benefits of high glycemic load to slow ALS disease progression with previous data on the increased risk for ALS associated with diabetes mellitus?
The relationship between diabetes and ALS is still controversial and poorly understood. Several recent studies, including observational studies in the general population, and Mendelian randomization studies, indicate that type 2 diabetes is associated with a decreased risk of ALS, especially in olde...
Would you consider starting dual antiplatelet therapy in a patient with evidence of petechial hemorrhage post-stroke secondary to ICAD?
Yes, petechial hemorrhage in a stroke would not change my decision to start a short-term course of dual antiplatelet therapy in a patient with TIA or minor stroke and ICAD.
How often is a contrast-enhanced brain MRI truly normal in the setting of spontaneous intracranial hypotension?
In a paper by D'Antona et al., PMID 33393980:"Of 6878 articles, 144 met the selection criteria and reported on average 53 patients with SIH each (range, 10-568 patients). The most common symptoms were orthostatic headache (92% [95% CI, 87%-96%]), nausea (54% [95% CI, 46%-62%]), and neck pain/stiffne...