Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What other conditions should you consider in someone with presumed Tolosa Hunt but without significant improvement on steroid therapy?
Sufficient workup should ideally be obtained before initiating steroids in order to exclude disorders that may have a similar presentation with quite a different approach to management. These investigations include but are not limited to the following: brain MRI with contrast + thin slices through t...
How do you decide on head-of-bed positioning after mechanical thrombectomy for acute stroke?
First, there is some evidence that HOB positioning is related to deterioration/improvement before endovascular thrombectomy (EVT) from the ZODIAC trial. Second, safety comes first. Follow your ABCs. If the airway is ok, the patient does not develop orthopnea with a supine position, and the BP is ok ...
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...
Would you recommend switching to DAPT for patients on anticoagulation who develop symptoms of a TIA secondary to ICAD?
It is important to remember that there is more to stroke secondary prevention than antithrombotics. Our use of DAPT in ICAD comes from the SAMMPRIS trial, in which patients in the control group did better than expected compared to historical controls with ICAD in the WASID trial. Recall however, tha...
What do you recommend as a first-line antidepressant in patients with major depressive disorder and migraines?
In my clinical practice, I have found SNRI medication, particularly extended-release venlafaxine (dosed from 37.5 mg to 225 mg), to be helpful for patients with both comorbidities. Other medication classes I have seen used to good effect include TCAs (amitriptyline, nortriptyline) and some SSRIs (se...
How do you triage intubation, EVD placement, or blood pressure control before transfer to a comprehensive center in high-grade aneurysmal subarachnoid hemorrhage?
I would triage intubation first to control the airway, which can be useful for controlling intracranial pressure via controlling pCO2. I think that is pivotal. The next thing I would do is EVD placement to allow control of intracranial pressure if appropriate. The third is blood pressure control, bu...
When are you using colchicine for stroke or MACE reduction?
Not right now. Some studies in cardiology are positive; others are negative. Also no dedicated positive studies in stroke.
How do you manage an MS patient who has had attacks in spite of being on B-cell depleting therapy?
True inflammatory breakthrough during adequately dosed, biologically effective anti-CD20 therapy is uncommon. Consequently, the initial response should prioritize diagnostic reassessment instead of immediate escalation.The first step is to confirm that the event represents a true relapse rather than...
How do you counsel patients with blepharospasm regarding driving?
I do not have a specific protocol for driving with blepharospasm, so I would advise assessing each case individually. Occupational therapy can perform standardized driving assessments for safety if there is a concern.
How do you treat extrapyramidal symptoms secondary to anti-psychotic use in patients who have not benefited from cogentin or benadryl?
In general, when addressing motor symptoms from antipsychotics (or any dopamine-blocking agents including dopamine-blocking antiemetics), I find it useful to break things down more specifically than just EPS. This often will determine the agent that will be most beneficial. First Category: Hypokinet...