Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Do you typically recommend anti-epileptic medication in patients with acute multi-compartmental intracranial hemorrhage?
In the absence of seizures, data/recommendations support the use of prophylactic anti-seizure medications (for 7 days only) if the multi-compartmental hemorrhages were caused by trauma. If the multi-compartment hemorrhages were due to an aneurysm rupture, then it might be prudent to use ant-seizure...
What is the diagnostic yield of working up suspected autoimmune encephalitis in patients with new onset behavioral disturbance without overt neurological deficits?
Unless there is another obvious cause for the behavioral change, I would consider this a neurological deficit. In my experience, such a work-up, including imaging and CSF analysis, is appropriate for any patient outside of the typical age range for new-onset mood disorder.
Under which clinical scenarios do you consider an inpatient EMG?
From my personal practice, inpatient EMG requests most often come at the behest of the neurology inpatient or neurology consult team, and very seldom, if ever, come from other primary teams. As such, having an initial neurological evaluation to "vet" the requests' appropriateness for inpatient versu...
How do you target therapy before the EEG is connected in a patient who comes to the ED in super refractory generalized convulsive status epilepticus once the convulsions resolve?
I infer from the context of your follow-up question that the patient was most likely intubated and started on an appropriate sedative drip. I have typically seen burst-suppression maintained for 48 hours, longer if the patient had failed such a duration in the past. Typically targeted therapy will i...
Do you perform apnea testing prior to ancillary tests in patients with suspected brain death who are unable to undergo complete brainstem testing?
I think this will depend on your institution's protocols. In general, ancillary testing is used as additional evidence ONCE the clinical brain death testing has been completed at the bedside, including the apnea test.Ancillary testing can be helpful when: portions of the brain death clinical exam ca...
Do you consider a severe ICA stenosis (70-99% narrowing per NASCET criteria) symptomatic if a lacunar stroke attributable to small vessel disease occurs in the perforating arteries (e.g. lenticulostriate) downstream from the stenosis?
This is a great question and I do not think there’s a definite answer for it. Indeed a small portion of subcortical lacunar infarcts is due to proximal embolism. On the other hand, lacunar infarcts and ECAD share multiple risk factors. Evidence of prior embolic-looking lesions, carotid plaque morpho...
What is the recommended approach for extracranial bleeding after tPA?
I almost never reverse for extracranial bleeding unless life-threatening. It can almost always be treated with tamponade, hemodynamic support, and transfusion.
How long do you wait before foley or IV placement in patients who have recieved TNK or TPA?
If foley is needed, especially if going to IR, etc., we place it before if possible, but often place it during infusion or even after if needed.
How do you manage patients with post spinal tap headaches?
There are two tracks of treatment to consider in these patients. The conservative path would be laying supine as much as possible or bed rest, aggressive hydration including intravenously, and caffeine consumption. This should be the first step and tried for 24 to 48 hours before considering procedu...
What is the normal range of spinal tap opening pressure?
Normal range is variable based upon supine versus sitting up, diurnal variations, etc., but the most important thing is what is considered "Low" and "High". For any patient, despite of age and BMI, supine opening pressure above 250 mm of water is considered high, and <6 mm of water is considered low...