Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Do you switch from Eliquis to Pradaxa in patients who experience a recurrent ischemic stroke while on Eliquis, considering their different mechanisms of action?
I tend not to switch patients from Eliquis/apixaban to Pradaxa/dabigratan. There is no good data to support this and while the mechanistic argument may make sense, especially since dabigatran, a direct thrombin inhibitor, was the only DOAC to reduce ischemic stroke events in a statistically signific...
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 you give TNK to patients presenting with transient global amnesia like symptoms within 4.5 hours?
In short, yes-depending on the case.If a patient had a transient episode of anterograde amnesia however, at the time of exam they have no difficulty with immediate and delayed recall or forming recent memories (over the last 30 minutes) without any other deficits then I the risks may be more than be...
What are your preferred beta blockers for migraine prevention treatment?
Beta blockers, originally developed for cardiovascular disease, were serendipitously discovered to reduce the frequency and severity of migraine attacks in the late 1960s. They remain the most widely used class of prescription preventive medications for migraine. Among beta-blockers, only propranolo...
What factors do you take into account when deciding the length of adjuvant temozolamide in GBM?
The field is evolving from 12 cycles to 6 for IDH-wildtype GBM in recent years, on the basis of some retrospective studies and notably the prospective Spanish study GEINO 14-01 - there does not seem to be much OS benefit, and there are also toxicity concerns (myelosuppression, hypermutation). Extens...
In patients with suspected RCVS, is there a role for preventative CCB if headache has resolved/now asymptomatic?
A number of these patients experience a dull, lingering headache, and I typically maintain them on verapamil, with or without magnesium, until their headache subsides. Afterward, I gradually taper off the medication over 7-10 days. I don't use it as a preventative measure as long as the patient is s...
How do you decide when to resume aspirin after stroke due to septic emboli with hemorrhagic conversion?
I look at multiple factors that include size and type of the hemorrhagic conversion, septic emboli elsewhere in the brain with associated blood products, MRI, mycotic aneurysms with subarachnoid blood products, and the indication for aspirin. If the patient is high heart risk because they had a rece...
How, if at all, do you anticipate incorporating Pixclara PET into the evaluation of suspected recurrent or progressive glioma after treatment?
I annticipate two major ways to employ Amino acid (or FET) PET. (1) Following the EANO consensus guidelines on radiation necrosis, these studies will provide complimentary information to perfusion MRI when evaluating treatment effects vs true disease progression [Duernick et al. Neuro-oncology 2026]...
What factors would guide your decision to safely resume anticoagulation for atrial fibrillation following a recent intracranial hemorrhage?
Whether a patient with atrial fibrillation and an intracerebral hemorrhage should resume anticoagulation depends on whether the bleed was attributed to cerebral amyloid angiopathy (CAA). Most patients with CAA should not be on long-term (lifelong) anticoagulation. If a bleed was attributed to hypert...
How do you manage glioblastoma presenting with leptomeningeal dissemination?
Hospice is a very legitimate option. As physicians, we recommend this far too infrequently.