Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
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...
How do you decide when to order an EEG to evaluate for non-convulsive status epilepticus in a patient admitted with acute encephalopathy?
This can be a challenging question to answer given the broad differential of acute encephalopathy and how available EEG is at your hospital. At centers with easily available EEG capabilities, the threshold to obtain an EEG will be lower. I will also assume this question is related to patients who ha...
Which patients do you find respond best to DHE nasal powder for acute migraine?
Unfortunately, I do not think that we can predict how patients will respond to any acute treatment. In patients who are naive to prescription abortive treatments in the US, we cannot predict which prescription abortive treatment will be effective, so the choice depends largely on the cost, insurance...
Can needle EMG or nerve conduction studies cause transient MRI abnormalities, such as apparent inflammation, edema, or enhancement of a nerve, that could be mistaken for neuritis on subsequent imaging?
Yes—needle EMG can create small, transient post-procedure MRI/MR-neurography abnormalities at needle insertion sites, including focal T2/STIR hyperintensity interpreted as edema and occasional small hematoma, which can potentially be mistaken for local pathology if the timing is not recognized. In a...
What is your approach to counseling older patients and their families regarding expected recovery of aphasia following a large hemispheric stroke?
There is no precise answer for this question. Every patient follows their own course after a stroke. The size of the infarct and the age of the patient will affect the prognosis. Older patients and those with larger infarcts tend not to have as much recovery. The improvement of aphasia can proceed o...
How do you approach evaluating the hemorrhage risk of restarting anticoagulation in a patient with ischemic stroke and infective endocarditis without access to DSA?
This is a really excellent question. First of all, if the patient has infective endocarditis, they really should undergo appropriate antibiotic treatment prior to initiating anticoagulation. I have seen several patients have significant (and in some cases fatal) hemorrhages because anticoagulation w...
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...
What is the role of skin biopsy for evaluating small fiber neuropathy in patients with rheumatic disease who have treatment recalcitrant pain?
I have a shared decision-making discussion with the patient, especially alluding to the fact that the result would not change my therapy (i.e., use neuropathic analgesics for treatment) for small fiber neuropathy (SFN). Where I find it especially useful is in a patient with systemic lupus (SLE) or S...
When do you consider prescribing memantine for migraine treatment?
Memantine is well-tolerated and shows excellent efficacy for prevention in both chronic and high-frequency episodic migraine. The main limitation is that it is not FDA-approved, and payors use this as an excuse to deny coverage in favor of less-well-tolerated, and often less efficacious but cheaper ...
In patients with medically-refractory left temporal epilepsy, and left dominant language and memory, how should you approach surgical intervention?
The approach is tailored to the individual patient and their particular case. If the neuropsychological profile suggests they have significant deficits already in verbal memory, then the risk is usually not as significant for them to notice a clinically meaningful post-surgical decline as it is for ...