Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you approach questions regarding clearance for elective surgery in patients with epilepsy?
I write a letter that gives a sense of how well-controlled the epilepsy is, emphasizes that ASMs should be taken on the morning of surgery as usual, and if hospital admission is needed, that they should be given on schedule during the admission as well. I then give some general tips on seizure first...
When do you consider starting short-term DAPT in patients who present more than 24 hours after the onset of a high-risk TIA or minor stroke syndrome?
Immediately. Unless tPA has been given, then at 24 hours.
How do you approach treatment of suspected CNS vasculitis with a negative work up?
Suspected CNS vasculitis is, simply put, extremely challenging, most often because the diagnosis is difficult to make. Commonly, the diagnosis is suspected based upon non-invasive imaging showing an unusual distribution of infarcts and/or evidence of intracranial arteriopathy (CTA or formal DSA). I ...
What have you found helpful in counseling patients with migraine reluctant to take preventative medications?
I think all of the responses here are very reasonable, but often the hesitancy is based less on resistance to a specific medication than on the self-stigmatization we see in patients with chronic headache, migraine, or other primary or secondary headaches. Because migraine is not a life-threatening ...
What are your top takeaways in Neuro Oncology from ASCO 2025?
Aizer et al., JCO 2025 - A multi-instituitional Brigham Dana-Farber-led trial randomized 196 patients with 5-20 brain metastases to stereotactic radiosurgery (SRS) or hippocampal avoidance whole brain radiotherapy (HA-WBRT). Patients treated on the SRS arm had significantly less symptom burden, wit...
Do you recommend any medical management for patients with evidence of intracranial atherosclerosis without evidence for stroke?
I would focus more on primary prevention strategies, including lifestyle modifications and high-intensity statin therapy if LDL is elevated. The evidence supporting antiplatelet therapy for primary prevention in patients with stroke risk or intracranial atherosclerosis is either lacking or not stron...
When do you obtain nerve biopsy to evaluate for vasculitic neuropathy in patients with distal symmetric polyneuropathies?
Excellent question. Vasculitic neuropathies can occur as part of systemic or isolated peripheral nerve vasculitis (PNSV). While the majority of PNSV presents as mononeuropathy multiplex (>50%), it is well known that the rest of the patients present either with confluent mononeuropathies (which began...
Would you consider empiric anticoagulation in patients with an acute stroke for whom you have high suspicion for cardioembolic source, but have not yet confirmed LV thrombus, atrial fibrillation, etc.?
In practice, I would rarely consider empiric anticoagulation after an acute ischemic stroke without a confirmed cardioembolic source. I would not consider this approach for suspected LV thrombus, as transthoracic echocardiography is routinely available in the inpatient setting and can quickly confir...
What treatments, after appropriate dose reductions/delays, do you offer for patients with oxaliplatin-induced cold allodynia/dysesthesia?
The primary treatments that I use for cold-induced oxaliplatin neurotoxicity are reducing the oxaliplatin dose and limiting the duration of oxaliplatin treatment (usually not more than 16 weeks of oxaliplatin-containing therapy in the initial line of treatment). Medications that are effective for pa...
Do you consider bleeding risk in elderly, frail patients with atrial fibrillation to be similar for all NOACs?
I believe that apixaban carries a lower risk of bleeding, with particular reference to GI bleed, when compared to rivaroxaban and dabigatran. This is true in the population of AF patients at large and most probably in frail patients as well.