Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Do you give TNK to patients presenting with transient global amnesia like symptoms within 4.5 hours?
This is a very interesting clinical question that does not come up practically very often. There is next to no study data available on the matter, so most of what I will propose here can be classified as an expert take. I think that the most direct, and clinically relevant way of approaching such a ...
How do you determine the time window for which to monitor for cerebral edema development in patients with brain injury?
The type of edema definitely matters. The two big categories of cerebral edema include cytotoxic and vasogenic edema. Cytotoxic results from free water accumulation in dying cells from acute brain injury, while vasogenic edema results in disruption of the blood-brain barrier. The classic teaching is...
Would you consider adding gabapentin off label for use in the treatment of glioblastoma at this time?
As an author on the paper, let me emphasize the findings and speculate on the implications. Recently, a number of laboratories have unraveled stunning preclinical and mechanistic findings demonstrating the ability of a subset of malignant glioma cells to usurp neuronal circuitry to promote tumor gro...
What is your approach to benign appearing (on MRI) septum pellucidum/intra-ventricular masses?
I typically view "benign appearing" on MRI as a helpful indicator but one that we usually can't altogether trust in isolation. I would consider size, symptoms, risk of obstruction, and any trajectory of change. I would at least consider cytology and cfDNA from CSF if biopsy is felt infeasible, and p...
How much does platelet mapping or platelet function analysis influence your management, particularly in patients with recurrent ischemic strokes despite being on dual antiplatelet therapy?
P2y12 or cyp2c19 testing when available is a reasonable part of the work up for recurrent strokes on dual antiplatelet. However it is only one aspect of the work up with the rest focusing on uncontrolled risk factors and untreated mechanisms like atrial fibrillation or carotid web or thrombophillia ...
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...
Have any of the findings from the 2026 AAN/AHS review of migraine prevention changed your practice?
Neither this nor other reviews or guidelines determine what I do in practice. I base what I do in practice on my knowledge and experience as well as on common sense, of course, always with the best interest of the patient in mind. As I mentioned earlier in posts and also emphasize in my book, HEADAC...
Do you typically give GI prophylaxis when providing patients with steroid taper for status migrainosus?
I usually do a 3-6 day taper with prednisone, dexamethasone, or medrol dose pack for status migrainous. Occasionally, I have done a 12-day taper if the status migrainous is prolonged. I have not used GI prophylaxis.
What is your approach to managing hallucinations in dementia?
Hallucinations in dementia can be categorized in many ways. To begin to conceptualize a management approach, it is useful to distinguish between various types of clinical presentation: pre-existing psychosis in a patient who then develops dementia; new onset psychosis in a patient with dementia; pre...
How do you manage and adjust Parkinson’s medication if a patient has worsening orthostatic hypotension while being treated with carbidopa/levodopa?
Levodopa is such an important pillar of Parkinson's therapy that it is often necessary to continue this drug despite the worsening of orthostatic intolerance.This is a step-wise approach (i.e., don't go to step 4 if you haven't addressed step 2): Ensure that the patient is getting symptomatic benefi...