Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Is there sufficient evidence yet to support the use of lithium supplementation or prescription in the management of neurodegenerative diseases?
No.I assume the question was written in response to a recent publication in Nature (Lithium deficiency and the onset of Alzheimer’s disease), highlighting recent research in mouse models where lithium deficiency in the brain led to accelerated amyloid pathology, which could be in part reversed by re...
When have you used suzetrigine for acute migraine treatment?
I have never used suzetrigine in migraine disorder. There are no studies or even case reports of its use in migraine disorder. It is not FDA-approved for migraine disorder indication. It is ~$500 for a month's supply. It would not be covered by insurance for a migraine disorder indication. I would n...
What treatment do you use for stroke prevention in cervical artery dissection?
Two prior RCTs (CADISS and TREAT-CAD) investigated this topic, each with distinct designs. The CADISS trial found no statistically significant difference in primary outcomes between antiplatelet and anticoagulation therapy for extra-cranial dissection. However, the TREAT-CAD trial failed to demon...
How do you counsel patients with GCA on the benefits of steroids who have already experienced vision loss?
I first tell the patient they are at considerable risk for further visual loss in the same eye or the other eye over the next 1-2 weeks. I also let them know that, even though their risk of visual loss has been reduced, their best option for preventing further visual loss is immediately starting hig...
What is your approach to management of severe hyponatremia in patients with alcohol use disorder who experience seizures that could be secondary to the electrolyte derangement or alcohol withdrawal?
Since it is difficult to make a definitive distinction as to whether the seizure is due to severe hyponatremia or alcohol withdrawal, it is prudent to treat both severe hyponatremia and alcohol withdrawal concurrently. Given that the seizure may be contributed to by the severe hyponatremia, 3% hyper...
How do you approach treatment of a young adult with an intracranial anaplastic ependymoma and a single intradural cervical spine metastasis?
A high-grade tumor, such as anaplastic ependymoma, carries a higher risk of CSF seeding down the neuroaxis than lower grades. Secondary spinal drop metastases are considered a serious but relatively rare complication in this disease. Assuming that the metastasis was detected at the time of diagnosi...
When do you opt for MRI brain in addition to CTA/CTP for evaluating eligibility for extended window thrombolysis?
In a patient with disabling deficits (regardless of location), if the last known well time is unknown, but the symptom discovery was within 4.5 hours, we pursue an MRI to assess for IV thrombolysis eligibility after obtaining the initial CT head and CTA, and if there is no intervenable (per standard...
How do you approach treatment of a glioblastoma in pregnancy?
Glioblastoma during pregnancy could be treated safely (to mother and fetus) with certain precautions and modifications. Collaboration and consultation with the patient’s obstetrician are essential. External shielding over the patient’s abdomen during treatment will decrease the external scatter radi...
What are your top takeaways in Neuro Oncology from ASCO 2025?
Aizer et al., JCO 2025 - A multi-instituitional Brigham Dana-Farber-led trial randomized 196 patients with 5-20 brain metastases to stereotactic radiosurgery (SRS) or hippocampal avoidance whole brain radiotherapy (HA-WBRT). Patients treated on the SRS arm had significantly less symptom burden, wit...
What extended window thrombolysis protocols are your institutions implementing?
Regulatory guidelines set time epochs for IV thrombolysis at 3h (US) and 4.5h (rest of the world). Recent guidelines are similar globally, supporting a 4.5h time window. The Canadian guidelines state that: “Intravenous thrombolysis beyond 4.5 hours may be considered, in consultation with a physician...