Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
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...
How do you manage patients with status dystonicus?
Many times, severe, seemingly uncontrollable generalized dystonia can occur in patients with or without a prior history of dystonia. In cases of severe encephalopathy, often treating the encephalopathy is the best overall approach, with medications specifically targeting the movement disorder used s...
Would you attempt a brain MRI in patients who present to the ER with subacute presentation of obstructive hydrocephalus?
I think an MRI is warranted to characterize the cause of the hydrocephalus in almost all cases, especially in the setting of a mass. The MRI can help identify the nature of the mass and the absolute size, and help with the differential diagnosis. It will also help you identify the mass as a solitary...