Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What MRI findings would you consider compatible with an acute seizure or seizures?
Frequent seizures and status epilepticus can result in reversible neuroimaging findings such as cortical enhancement, DWI cortical ribboning, and decreased attenuation on CT. Imaging findings can be resolved with control of seizures.Hormigo et al., PMID 15023812Kramer et al., PMID 3653056Riela et al...
When do patients with descending paralysis and suspected botulism require inpatient EMG?
If a health care provider suspects botulism in a patient presenting with descending paralysis (beginning from the cranial/bulbar region) and certain clues such as autonomic nerve involvement with dilated poorly reactive pupils, constipation, etc. can help, then treatment must be administered immedia...
What serum biomarkers are most helpful in cardiac arrest prognostication?
Neuron-specific enolase. This is checked at 24, 48, and 72 hours. It is, however, NOT to be used in isolation for prognostication, which is multimodal, including clinical exam after clearance of sedation (typically at 5 days post arrest), EEG (e.g., looking for reactivity of background), NSE, and MR...
When should you seek hyperbaric oxygen therapy for patients with CRAO?
I usually pursue hyperbaric oxygen therapy within the 24-hour window from symptom onset for CRAO. This can be performed following TNK if given. In reality, though, there are multiple barriers to achieving this, including: Few centers offer hyperbaric oxygen therapy Labor intensive Difficulty with i...
How do you determine if generic vs. brand formulation of a DMT is the probable cause of worsening multiple sclerosis disease activity?
I based this on the timing of the switch to generic formulations and the duration of stability on brand formulation. For example, if a patient has been on brand DMT with stability for 5 years, then recently changed to generic with disease activity within the first year, I would consider that the gen...
Do any subgroups of headache patients benefit more from neuromodulation devices compared to pharmacologic treatment?
I think patients with episodic cluster headache benefit greatly from external vagus nerve stimulation (gammaCore) use. This device aborts cluster attacks and has a preventative action as well for future attacks during a cluster bout. It allows for more than 2 treatments per day if the patient is hav...
Would you recommend muscle or nerve biopsy in a patient with amyoplasia congenita?
No, I would not for at least 2 reasons. The probability of getting a quality sample is very low, and it is most likely that no muscle would be obtained as the name of the disorder implies (amyoplasia). Furthermore, the likelihood of finding a genetic cause for this is VERY low. In fact, in using WES...
Is there sufficient evidence yet to support the use of lithium supplementation or prescription in the management of neurodegenerative diseases?
No.I assume the question was written in response to a recent publication in Nature (Lithium deficiency and the onset of Alzheimer’s disease), highlighting recent research in mouse models where lithium deficiency in the brain led to accelerated amyloid pathology, which could be in part reversed by re...
What is your approach to Tardive Dyskinesia when VMAT2 inhibitors are ineffective or unaffordable?
In established cases of tardive dyskinesia, in which withdrawal-emergent dyskinesia has been ruled out, and dyskinesia has persisted despite a sufficient washout interval after removal of the offending agent, VAM2 inhibitors such as valbenazine and deutetrabenazine are used for pharmacotherapy. If t...
How will your approach to screening and diagnosis of early dementia change given newly available therapies for early Alzheimer's disease?
As it stands, it is not recommended to screen asymptomatic patients for the proteins seen in Alzheimer’s disease outside of clinical trials (i.e., AHEAD 3-45). However, with the emergence of new treatment options in the clinic, I foresee an influx of patients with cognitive symptoms who need a preci...