Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What do you recommend to patients when they are having an acute flare of fibromyalgia symptoms?
Great, this is a really important area and unmet need in the field of fibromyalgia management. Unlike other nociplastic disease states (e.g., migraine), there are no rigorously studied abortive therapies to rapidly treat a flare of centralized pain. Indeed, all the therapies we use for FM are intend...
How do you utilize OCT for the diagnosis and management of IIH?
OCT can be a valuable adjunctive objective tool for diagnosing and monitoring papilledema in IIH. However, when it is used, it should not be used alone. It must be integrated with perimetry and fundus exam/photography. It has important limitations that preclude its use as a standalone modality.Limit...
What is your hemoglobin target for PRBC transfusion in cases of acute brain injury?
At our institution, our hemoglobin goal has always been 7 except for TBI patients, in which the goal has been 8.5. The TBI goal was a bit arbitrary and really just split the difference between 7 and 10 given some of the contradictory data. Given the new HEMOTION and TRAIN trials, we are revisiting o...
How does comorbid epilepsy influence your decision on antipsychotic medications?
In general, epilepsy is not a contraindication to the use of antipsychotic medications if they are needed despite the known risk of lowering the seizure threshold. In general, the risk of seizures for most antipsychotics is low, though some antipsychotics, such as clozapine, olanzapine, and quetiapi...
What is your first-line therapy for acute migraine treatment in the ER?
When guidelines are based on well-done, randomized trials, I tend to pay more attention to them. The most recent 2025 guidelines for treatment of migraine in the ER, first author Dr. @Dr. First Last, are excellent. Giving IV prochlorperazine cautiously may be a good start. Depending on the timing of...
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.
What is your preferred first-line treatment for chronic fatigue in patients with long COVID-19?
Assuming that a thorough workup for other causes of fatigue (anemia, thyroid dysfunction, sleep apnea, etc.) has been performed and is negative, no single medication has been proven by a randomized placebo-controlled trial to help chronic fatigue in PASC. Anecdotally, my colleagues who treat PASC ha...
Do you add antiplatelet medications to patients already on anticoagulation for atrial fibrillation if they have a stroke due to a competing etiology?
Adding antiplatelet therapy to anticoagulation in patients with atrial fibrillation and a noncardioembolic stroke has not shown a clear benefit and definitely increases bleeding risk. Okazaki et al., PMID 41051787 did not find a benefit and increased bleeding risk. An exception might be in acute MI ...
How do you approach evaluating the hemorrhage risk of restarting anticoagulation in a patient with ischemic stroke and infective endocarditis without access to DSA?
This is a really excellent question. First of all, if the patient has infective endocarditis, they really should undergo appropriate antibiotic treatment prior to initiating anticoagulation. I have seen several patients have significant (and in some cases fatal) hemorrhages because anticoagulation w...
When do you use anticoagulation over antiplatelet therapy for secondary stroke prevention in patients with LV injury or dysfunction?
First, I will observe that the recent work is a cohort study, not an RCT< and I would be careful about concluding that anticoagulation is the best approach. We have had prior trials, e.g., WARCEF and the related ESUS trials (NAVIGATE and RESPECT), and others that have looked at possible cardioemboli...