Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
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...
What are some commonly missed diagnoses that should be considered in cases of otherwise seronegative yet steroid-responsive autoimmune encephalitis?
One shouldn't neglect to consider lymphoma as another differential in such cases as there had been reports of lymphoid malignancies presenting in such a manner. Ideally, cytology and flow ctyometry would have been obtained at the initial presentation since steroids may alter a CSF profile which migh...
What is your approach to the management of worsening dystonic spasms that are painful and refractory to standard dystonia medications?
Agree with Dr. @Dr. First Last, my friend. I would also add physical therapy specifically asking for a muscle mobilization therapist within a week after chemodenervation. Physical therapy really helps after treatment or without treatment. Also, set realistic expectations about pain management: remin...
Can Guillain-Barre syndrome present with intact reflexes?
GBS is hallmarked by ascending weakness and loss of reflexes simplistically put, with a mean Nadir of 9 days.Tendon reflex loss occurs early in most (70%) but not all patients, progressive reduction during 1st week with the clinical pattern of distribution were in ankles most frequently lost; biceps...