Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
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...
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...
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...
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...
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...
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...
How do you approach evaluation of a patient referred for mononeuritis multiplex and +SSB?
Step 1: A clinical syndrome of mononeuropathy multiplex always requires an EMG study. Is the primary mechanism of the MnM axonal or demyelinating? If it is demyelinating, there are only two possible diagnoses: multifocal CIDP (Lewis Sumner syndrome, which can occur in the context of Sjogren's syndro...
What clinical or imaging features help distinguish intracranial atherosclerotic disease from intracranial dissection in the setting of an LVO?
This is a great question and very difficult to answer. I think the first thing I look for is whether there is significant atherosclerosis elsewhere. Lack of significant atherosclerosis elsewhere with a single significantly stenotic intracranial lesion in a young person or someone without significant...
In an older adult hospitalized with recurrent falls, weight loss, without clear injuries, but with an inconsistent or difficult-to-reach caregiver, what findings would make you formally report suspected elder neglect and/or abuse?
I'm so glad that you're thinking about the possibility of abuse/neglect in this scenario! It's important to have it on our differential, or we'll always miss this diagnosis. First, it would be good to see if the patient can explain what is happening and provide contextual information that veers us a...