Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Would you recommend a CT venogram or MR venogram in patients with concern for venous sinus thrombosis?
Either modality is suitable for assessing CVST. However, I typically prefer CTV. It's easier to obtain and has a quick scan time, which reduces the chances of motion artifacts. MRV provides better resolution, but it requires a screening form and has a longer scan time, which may lead to motion artif...
In a patient with presumed autoimmune encephalitis, would treating them with IVIG before getting a brain biopsy alter the pathological changes in a meaningful way?
I don't think IVIG would meaningfully alter the results of a brain biopsy. However, a biopsy is frequently less informative in diagnosing autoimmune encephalitis compared to CSF and serum autoantibody testing. It's worth noting that IVIG can trigger aseptic meningitis, so it's essential to exercise ...
How do you manage patients with embolic stroke of an undetermined source and a papillary fibroelastoma found on an echocardiogram?
The definitive treatment is surgical, and the only way of knowing for certain that the lesion is a fibroelastoma is to perform surgery and obtain pathology. If a patient is not a candidate for heart surgery, anticoagulation could be tried.
Do you typically load DAPT in patients with ICAD?
If the ICAD lesion is symptomatic and the patient is aspirin-naive, I administer a one-time loading dose of 325 mg of aspirin, followed by 81 mg after that. I do not administer a loading dose of the P2Y12-inhibiting agent (such as clopidogrel, ticagrelor, etc.). I continue DAPT for 3 months then tra...
Do you recommend any particular type of contraceptive use in young patients with strokes of unclear etiology?
The safest choice would be a progesterone-only method. If a combination must be used, the lowest estrogen option.
How do you initiate steroids in ocular Myasthenia Gravis?
It's the same with generalized MG. The only difference is that I avoid increasing the dose to more than 30-40 mg of prednisone per day (if possible). Many experts propose initiating dosing every other day, but I have never been a big fan of this regimen because I have seen several patients experienc...
Are there certain sedatives or anti-epileptic meds to avoid in patients with IDD?
They are very interesting questions and I think “do no harm” relates to the issue of using any medication, whether it's an anti-epileptic drug or something for pain, or anything. Any medication can have an impact. When you think about someone with an intellectual or developmental disability (IDD) w...
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.