Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
In patients being evaluated for brain death, which abnormal movements are definitively known to still be consistent with brain death and which are possibly consistent with brain death but lack definitive evidence?
This is indeed a challenging question, one that I continue to grapple with as a neurointensivist. Fortunately, most brain-dead patients do not exhibit any movements in response to noxious stimuli, but some case series report reflexive movement in up to 75% of cases. The classic teaching is that only...
How do you medically manage acute basilar artery occlusion in patients with low NIHSS who are not candidates for EVT but at risk for deterioration?
First, I would consider endovascular therapy even with a low NIHSS, if the patient is otherwise a good candidate. If this were not possible, I would angicoagulate with IV heparin initially, then a DOAC (direct oral anticoagulant).
When would you refer patients with Parsonage-Turner syndrome for surgical treatment?
An introduction is required because this is a relatively new concept in the management of neuralgic amyotrophy.Despite historical data from the '90s suggesting that >80% of Parsonage-Turner (neuralgic amyotrophy/NA) patients will show significant improvement of motor function in two years after the ...
How do you manage AEDs in patients with malignant brain tumors?
Use of prophylactic anti-seizure drugs in patients with primary malignant brain tumors is not recommended and has been evaluated in multiple systematic reviews and guidelines including a recent systematic review and well-done guideline paper from SNO and EANO published by Tobias Walbert, Elizabeth G...
What is your approach to the treatment of idiopathic intracranial hypertension with transverse sinus stenosis?
I don't know of a way to determine whether the venous stenosis is the cause. It's a common finding in intracranial hypertension and unclear whether it is the cause or effect of intracranial hypertension. If the patient is not having vision deterioration and can be managed with medication and weight ...
What is the preferred approach to managing non-occlusive or partially occlusive venous sinus thrombosis?
I would recommend a DOAC, particularly apixaban, with follow-up imaging in 3 months.
Is vaginal delivery safe in patients diagnosed with pseudotumor cerebri (IIH)?
This is a challenging situation. Unfortunately, both acetazolamide and topiramate are relatively contraindicated due to potential teratogenicity. Probably the most effective treatment is weight loss, just like with non-pregnant patients. However, this is easier said than done, especially in pregnanc...
Beyond fatigability, what distinctive features of diplopia characterize myasthenia gravis?
The key to ocular myasthenia is variability- maybe more than fatigue. If the diplopia is always in the same direction and even more clearly stemming from one eye (and muscle) then this is more likely to be an isolated muscle weakness- whether from nerve disorder or latent strabismus. But if the dipl...
How do you manage immunotherapy-induced myasthenia gravis?
My go-to algorithm is well-represented in the paper by Dr. @Dr. First Last et al. Zubair et al., PMID 36439604
What is your workup and treatment approach for cranial neuropathies in patients with lupus?
Pretty much the same as is done for SLE patients presenting with acute or chronic inflammatory peripheral neuropathies with the additional concern for leptomeningeal inflammation. Evaluation: Cranial MR, CSF studies (cell count, albumin, IgG level with accompanying serum levels to determine IgG Inde...