Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Where in your treatment approach to fibromyalgia will you recommend sublingual cyclobenzaprine?
The choice of medication for any given patient is based on a lot of factors and, realistically, is often highly dependent on affordability and insurance coverage across different pharmacy plans. Despite other FDA-approved options, oral cyclobenzaprine is usually the medication I reach for first with...
How does the presence of 1-3 microbleeds on MRI influence your choice of anti-amyloid therapies for patients with MCI or mild AD?
1-3 microbleeds is a small number, and the question does not specify that to be suspicious for amyloid angiopathy, the microbleeds should be cortical/subcortical, not deep (as seen in hypertensive individuals). This number, assuming that there are no signs of a larger hemorrhage nor superficial side...
Would you start cholinesterase inhibitors for a patient with MCI or mild dementia based on MoCA testing, when there is concern for frontotemporal dementia?
No, there is no benefit of cholinesterase inhibitors and even a risk of harm from them in FTD.
Does global brain atrophy increase risk for intracranial bleed after fall in older adults?
It depends on the location of the hemorrhage. Subdural bleeding/hematoma is much more likely in elderly people with brain atrophy and a fall. Epidural hemorrhage is much more common in young patients. Intracerebral hemorrhage is more related to risk factors such as hypertension in middle age and amy...
When do patients with descending paralysis and suspected botulism require inpatient EMG?
If a health care provider suspects botulism in a patient presenting with descending paralysis (beginning from the cranial/bulbar region)- and certain clues such as autonomic nerve involvement with dilated poorly reactive pupils, constipation, etc can help- then treatment must be administered immedia...
What serum biomarkers are most helpful in cardiac arrest prognostication?
Neuron specific enolase. this is checked at 24, 48 and 72 hours. It is however NOT to be used in isolation for prognostication, which is multimodal including clinical exam after clearance of sedation (typically at 5 days post arrest), EEG (e.g. looking for reactivity of background), NSE, and MRI dif...
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...
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...
Do any subgroups of headache patients benefit more from neuromodulation devices compared to pharmacologic treatment?
I think patients with episodic cluster headache benefit greatly from external vagus nerve stimulation (gammaCore) use. This device aborts cluster attacks and has a preventative action as well for future attacks during a cluster bout. It allows for more than 2 treatments per day if the patient is hav...
At what degree of lymphopenia do you switch/discontinue dimethyl fumarate in patients with multiple sclerosis?
I do not check the JC index status for my patients on fumarates. While I do not have recent data, to my knowledge, there are only a handful of PML cases attributed to fumarates used in MS. Even when including fumarates used in treating psoriasis, the PML numbers are small. Since the prognostic value...