Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Have you changed your practice in treating CRAO with IV thrombolysis?
The recent THEIA trial had a limited sample size to draw conclusions, even though there was a non-significant trend of improved visual acuity initially in the thrombolysis group. Even the TenCRAOS trial had a small sample size with recruitment challenges, where subtle small differences cannot be acc...
How do you treat nocturnal leg cramps?
Nocturnal leg cramps are similar to daytime leg cramps, but stretching may be less convenient to use as a remedy, as sleep can be further disrupted. Treating and preventing leg cramps typically utilizes some combination of hydration and electrolytes but sometimes, medications can help. Consider the ...
Is moderate-intensity statin plus ezetimibe just as effective as high-intensity statin monotherapy in preventing major cardiovascular events?
The secondary stroke prevention trial showed that high/moderate-intensity statin therapy combined with ezetimibe and titrated to achieve LDLc <70 were equally effective (compared to goal LDLc <100). Overall, the most important determinant of risk reduction is the achieved LDLc, and so moderate inten...
Do you require a lumbar puncture to evaluate for infectious etiologies before starting steroids for possible transverse myelitis seen on MRI?
Yes, I would perform a lumbar puncture alongside an MRI of the brain and cervical/thoracic spine with contrast to evaluate for potential infectious and inflammatory etiologies prior to starting steroids. LP is especially important if the patient has a fever, other symptoms of infection, or is immuno...
Has the April 2026 Cochrane review on anti-amyloid antibodies changed how you counsel older adults with early Alzheimer's disease about whether to pursue treatment with lecanemab or donanemab?
The April 2026 Cochrane review has not fundamentally changed my counseling, but it has strengthened my caution. It reinforces that lecanemab and donanemab clearly remove amyloid, yet any average clinical benefit appears small and remains difficult to interpret confidently given the numerous threats ...
How do you decide when to obtain a brain CT and/or MRI in hospitalized patients with altered mental status?
Always, unless the patient can be quickly awakened by glucose, etc., or it NDR, so I guess this means often.
What types of cardiac conduction abnormalities would lead you to avoid using tricyclic antidepressants?
I wouldn’t say it is a definite contraindication. But, I would want to be sure it is a longstanding patient and they are seeing a cardiologist regularly. Then, if the QTc were within reason, I would consider it; but it wouldn’t be high on my list of options.
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 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 (See Alexandrov et al JAMA Neurol. 2025;82(9):905–914. doi:10.1001/jamaneurol.2025.2253)Second, safety comes first. Follow your ABCs. If the airway ...
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...