Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
When do you suspect an autoimmune encephalitis in a child or adolescent with new-onset psychosis?
Given the rarity of true childhood schizophrenia, autoimmune encephalitis, and other medical etiologies should be considered in any patient presenting with new-onset psychosis prior to age 13. In adolescents, sudden onset of symptoms, absence of family history, lack of prodrome, and other atypical p...
What is your approach to determining eligibility for hospice in persons with Alzheimer's disease?
We strongly recommend early hospice enrollment for patients with dementia as soon as they meet eligibility criteria. In our approach, we carefully evaluate both functional and cognitive decline. One area that is often overlooked, however, is nutrition. When a patient with Alzheimer’s disease begins ...
When do you check thoracic paraspinals on needle EMG in suspected myopathy or myositis?
The need to sample the paraspinal muscles (especially thoracic) in suspected myopathy is diminishing with more sophisticated genetic testing and better antibody testing for inflammatory myopathies. The most common disorder that people learn to remember to sample the paraspinal muscles in Pompe disea...
What objective tools do you use to help determine if a patient is too high risk for anticoagulation to prevent stroke or DVT?
There are a number of risk scores, like HAS-BLED, that can be used, but I continue to use clinical judgment and shared decision-making. The excellent risk profile of NOACs and the availability of LAAO mean that I can usually come up with a solution for almost every patient that will protect them fro...
Would you consider adding gabapentin off label for use in the treatment of glioblastoma at this time?
As an author on the paper, let me emphasize the findings and speculate on the implications. Recently, a number of laboratories have unraveled stunning preclinical and mechanistic findings demonstrating the ability of a subset of malignant glioma cells to usurp neuronal circuitry to promote tumor gro...
How to approach reversal of TNK in hemorrhagic conversion of ischemic stroke?
There is no specific "reversal agent" for tenecteplase. Once administered, the thrombolytic effect will persist until the drug is fully metabolized and any residual plasmin has been cleared by alpha-2-antiplasmin. So, perhaps the first question is what can you do if there is an acute bleeding event ...
Do you wait to treat small asymptomatic brain metastases until they reach a certain size?
I typically treat all lesions on MRI that are found to be concerning for brain metastases. This is after a discussion with our neuroradiologist colleagues. If there is uncertainty that a small lesion may not be a brain metastasis, then I will elect to follow with a surveillance MRI and treat in the ...
What do you do as part of a baseline neurologic exam pre-CAR-T therapy in addition to the ICE score?
I treat pediatric patients, and we do a baseline routine neurological exam before CAR-T, nothing else specific.
Under what circumstances do you recommend POCUS guidance for lumbar puncture?
I agree with Dr. @Dr. First Last. As with many other skills in medicine, repetition is key to mastering POCUS skills. So, if available, I always use ultrasound to assist with lumbar punctures. You are improving your skills and increasing your success rate at the first needle pass, improving patient ...
How do you manage Moya-Moya disease medically for patients that are unable to receive EC-IC bypass?
It depends on the cause. Usually for patients either moya moya disease (in contrast to moya moya syndrome where symptomatic patients would benefit from EDAS or surgical management ) due to atherosclerosis or radiation induced if someone has continued ischemic events or silent infarcts on aspirin mon...