Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What are your go-to options for managing ICU delirium in patients with contraindications to antipsychotics?
Evidence for Ramelteon (Yu et al., PMID 36726202)Delirium with behavioral disturbances Depakote Clonidine Propranolol, especially with TBI Non pharmacological Make sure they're closer to the nursing station. Constant re-orientation. Shades open during the day and close at night. Bring anything they ...
What is your approach towards continuing cancer screening in a young adult with Tif-1+ dermatomyositis, and negative initial CT chest/abd/pelvis?
Young TIF-1 is likely behave as juvenile DM with TIF-1, where the risk of cancer is much lower. I have many young TIF-1 that never developed cancer. I still think that careful ongoing monitoring is needed for 3 years from diagnosis. For cancer risk assessment and management, use the International gu...
For patients with hydrocephalus secondary to leptomeningeal disease, how do you determine what type of shunt device to place?
I don't think one is especially better than another from a hydraulic point of view. The Certas Plus valve offers the "virtual off" setting so that IT chemotherapy can be allowed to circulate for a period of time before the shunt is "turned back on".
Should ASPECTS be used to determine eligiblity for thrombolysis beyond 4.5 hours?
You can use CT and CTA (often mCTA) to decide to thrombolyse beyond 4.5h. You do not necessarily require CTP. Both cohort studies and at least two randomized trials have reported benefit from this approach. ASPECTS is a measurement scale dependent on the quality of the NCCT imaging, the quality and ...
How do you approach an acute non-LVO stroke with a known large core (>70 mL, 0-5 ASPECTS, or other metric)?
As with any treatment, you have to weigh the individual patient characteristics and overall risks vs. benefits. If there is no LVO, then the question is whether to pursue thrombolysis. In the extended window, thrombolysis was really only helpful in very small core patients, so if the patient is beyo...
When do you consider EVD in pediatric severe TBI when initial imaging is unremarkable?
The guidelines state that intracranial pressure monitoring is indicated for severe TBI when GCS is 12 or less, regardless of what the head imaging looks like. Either a bolt or an EVD can be used for measuring intracranial pressure. In cases where our index of suspicion for elevated intracranial pres...
How long can demyelinating findings persist on nerve conduction studies (NCS) after AIDP illness?
This question was studied in a retrospective review in Muscle and Nerve (Guémy et al., PMID 36814082) in a group of patients with AIDP. At least one feature of demyelination was present in 23% of the cohort (14 out of 61) up to 2 years after the onset of the AIDP-like illness. Using the EFNS-PNS cri...
How do you treat behavioral changes in patients with temporal lobe epilepsy?
People with epilepsy (PWE) are much more likely to suffer from comorbid psychiatric problems during their lifetime, with about 1 in 3 PWE experiencing psychiatric symptoms at some point. In general, patients with psychiatric symptoms and coexisting epilepsy should be managed much the same as anyone ...
How do you manage patients with atrial fibrillation having a thromboembolic infarct despite being on adequate anticoagulation?
This scenario is always challenging. In terms of anticoagulation, the efficacy of DOACs in preventing embolic events in AF patients is around 70%, which is impressive compared to warfarin but not foolproof. In cases of a second embolic event while on anticoagulation, two reasonable approaches are of...
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 (Aron et al., PMID 40770094), highlighting recent research in mouse models where lithium deficiency in the brain led to accelerated amyloid pathology, which could be in part reversed by replacement.I want to remind th...