Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you decide between second-line immunotherapy for multifocal motor neuropathy?
There is no FDA-approved second-line immunotherapy for MMN, and there is no single drug with established efficacy from a randomized placebo-controlled clinical trial. In the 1990s and 2000s, there were a couple of case reports indicating efficacy of cyclophosphamide (Pestronk et al., PMID 7969954, B...
How do you treat steroid-refractory MS flares when PLEX is unavailable?
There is limited evidence on the efficacy of IVIG for MS relapses. A repeat course of IV methylprednisolone within 2-3 weeks could be considered. If the patient is not already on high-efficacy DMT, then I would also promptly initiate anti-CD20 therapy.
How do decide on extending an NCS for a suspected CIDP patient but so-far negative testing?
In a patient with suspected CIDP, when nerve conduction studies of 1 upper and 1 lower limb do not show sufficient abnormalities to meet the EAN 2021 diagnostic criteria, I would test at least 1 more limb, and preferably the contralateral upper limb. Some colleagues would test all 4 limbs in this co...
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...
In a young patient with recurrent low-grade glioma s/p gross total resection, is there any role for further observation instead of radiation and chemotherapy?
As simple as this question seems to be on the surface, it is actually a very difficult clinical scenario to opine with certainty, primarily because of a lack of data. So, let us address this with each option in mind, weighing the pros and cons: Observation: We do know that in resected patients, radi...
How do you manage glioblastoma presenting with leptomeningeal dissemination?
Hospice is a very legitimate option. As physicians, we recommend this far too infrequently.
What early clinical findings help in differentiating CIDP vs. POEMS?
I would like to share that I had a very challenging experience last year with a patient ultimately diagnosed with POEMS by myself, after more than one year of treatment as CIDP. There were multiple reasons it was challenging:1.) The patient presented initially with NO systemic features - just the ne...
When should you seek hyperbaric oxygen therapy for patients with CRAO?
I usually pursue hyperbaric oxygen therapy within the 24-hour window from symptom onset for CRAO. This can be performed following TNK if given. In reality, though, there are multiple barriers to achieving this, including: Few centers offer hyperbaric oxygen therapy Labor intensive Difficulty with i...
When should one consider obtaining a cardiac MRI in ischemic stroke patients?
This is a terrific question. Cardiac MRI is increasingly utilized in the diagnostic evaluation of ischemic stroke and can uncover clinically covert cardiovascular disease. The clinical utility in ischemic stroke is most in patients with concern for LV thrombus (low EF or recent anterior ST elevation...
Has the April 2026 Cochrane review on anti-amyloid antibodies changed how you counsel older adults with early Alzheimer's disease about whether to pursue treatment with lecanemab or donanemab?
The April 2026 Cochrane review has not fundamentally changed my counseling, but it has strengthened my caution. It reinforces that lecanemab and donanemab clearly remove amyloid, yet any average clinical benefit appears small and remains difficult to interpret confidently given the numerous threats ...