Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
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 ...
What are your top takeaways from AHS 2026 Scientific Session?
1. Earlier, phenotype-driven treatment of post-traumatic headache (PTH) is gaining momentum. Early treatment of post-traumatic headache using both acute and preventive strategies is increasingly favored, with management tailored to headache phenotype and risk factors for persistence. Nutraceuticals ...
What are your preferred second-line medications for trigeminal neuralgia?
My first line is oxcarbazepine or carbamazepine. The second line is gabapentin. Then, in no particular order, baclofen and lamotrigine. Other options to try: pimozide, tizanidine, phenytoin, valproic acid. If 1 agent does not provide good control, I refer to a surgeon as we try a 2nd agent.
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...
What is your first-line therapy for acute migraine treatment in the ER?
Regarding the abortive and preventive treatment of migraine, in the office or ER, we should focus on migraine-specific medications. These are the ergots, triptans, and gepants abortively, and the CGRP antibodies and gepants preventively. The patients who visit ERs every so often tend to have headach...
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 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...
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...