Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you counsel patients with postural orthostatic tachycardia syndrome (POTS) regarding safe and effective exercise regimens?
It depends on where they're starting from. If they're starting from scratch, I give them two recommendations: first is the Children's Hospital of Philadelphia protocol, and if they live in town, I refer them to our PT facility at Vanderbilt (The Dayani Center) to have our PT folks help them get star...
What is your preferred treatment for rhinorrhea in patients with Parkinson's disease?
This review paper discusses several treatment options for rhinorrhea in Parkinson's disease: Chen et al., PMID 36382119. This paper discusses exocrine gland dysfunction more broadly: Munhoz et al., PMID 41902376.Keep in mind that some dopamine agonists can increase rhinorrhea, so consider switching ...
Which calculators, nomograms, or other resources, if any, do you use to help advise and prognosticate patients with newly diagnosed glioblastoma or other gliomas?
This is a rather difficult question to answer because prognosis in patients with glioblastoma (GBM) is best estimated by combining several clinical, molecular, radiographic, and treatment-related factors rather than relying on any single variable. Several validated prognostic models exist, but in cl...
Do you ever use ocular ultrasound in evaluation of papilledema?
As a neuro-ophthalmologist, I never use ultrasound to make a diagnosis of papilledema. I do use it to reveal optic nerve head drusen that also cause axoplasmic flow stasis and can mimic papilledema. A high quality set of fundus photos is very useful for determining the presence of optic disc edema.
What early clinical findings help in differentiating CIDP vs. POEMS?
I would like to share that I had a very challenging experience last year with a patient ultimately diagnosed with POEMS by myself, after more than one year of treatment as CIDP. There were multiple reasons it was challenging:1.) The patient presented initially with NO systemic features - just the ne...
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...
When do you use greater occipital nerve block to treat acute refractory migraine?
I frequently offer ONBs for patients with acute migraine when they have persistent headache, despite migraine cocktail & other initial ER interventions. Since occipital nerve blocks are safe, effective, and have Level A recommendations from the American Headache Society, I perform them quite frequen...
Which molecular pathology findings make an oligodendroglioma too risky for upfront vorasidenib, or which other clinical characteristics do?
I still predominantly use grade/proliferation/presence of enhancement (would be more likely to use vorasidenib in a grade 2 nonenhancing tumor) as well as clinical criteria similar to those used in Pignatti et al., PMID 11956268, or large trials like RTOG 9802 (size at diagnosis, spread across midli...
Do you recommend normobaric hyperoxia for thrombectomy patients?
Not yet. Below is my take: Trial Summary 120 patients were randomized at two comprehensive stroke centers in China with anterior-circulation LVO presenting 6-24 hours after onset to EVT plus normobaric hyperoxia (NBO) or EVT alone. NBO consisted of 100% oxygen at 10 L/min by face mask for 4 hours, i...
When do you consider starting short-term DAPT in patients who present more than 24 hours after the onset of a high-risk TIA or minor stroke syndrome?
The literature states that DAPT is most effective when started within the first 24 hours after such an event, but is still effective as far as 72 hours later. So if the patient presents more than 24 hours later, but not later than 72 hours, I would still start it then but would want a CT scan first.