Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What workup do you suggest for patients with concern for opsoclonus-myoclonus syndrome?
Opsoclonus-myoclonus syndrome (OMS) is characterized by fast and irregular multidirectional eye movements combined with generalized myoclonus and often ataxia. The common etiologies include paraneoplastic, autoimmune, and infectious/parainfectious causes. The approach in children and adults is diffe...
What are your preferred treatments for vasospasm in the setting of RCVS?
In the inpatient setting, I like nimodipine. However, in the outpatient setting, patients may not want to, may not be able to, or may not remember to reliably take the medication every 4 hours. As you can imagine, this would be quite disruptive to their overall daily schedule and possibly their qual...
How do you treat persistent headache after a CVST diagnosis?
Follow the phenotype - usually migraine preventives, nerve blocks work well, or neuroleptics with gabapentin or Lyrica. Can be very difficult to treat.
How do you decide on the next therapy for post-ICI triple M syndrome (myositis/myocarditis/myasthenia) after steroids, PLEX, and IVIG?
The short answer is that there is no standard of care, and no way to reliably predict which of the third-line treatments will work best for each individual. As an introduction, 3M syndrome is a horrible combination of 3 immune-related adverse events (iRAEs) after ICI exposure for cancer, including m...
At what point do you refer patients to neurology for evaluation of tics?
I will only refer to neurology if there are other neurologic signs or other movement issues.
How do you manage patients with atrial fibrillation having a thromboembolic infarct despite being on adequate anticoagulation?
This scenario is always challenging. In terms of anticoagulation, the efficacy of DOACs in preventing embolic events in AF patients is around 70%, which is impressive compared to warfarin but not foolproof. In cases of a second embolic event while on anticoagulation, two reasonable approaches are of...
Does a patient’s ability to get risk factors under control influence your recommendation for surgical vs. medical management of asymptomatic carotid disease?
Controlling risk factors is paramount, regardless of medical versus surgical management. For asymptomatic disease, primary prevention is the goal, as opposed to the secondary prevention measures we commonly reference.Since CREST-2 was published in late 2025, there has been a lot of discussion on how...
Do you counsel patients to acutely treat migraine with aura at the onset of aura or headache?
The timing of acute treatments for migraine attacks has been widely discussed for a number of years. Here are some principles: Once the pain begins, pain-free rates are higher if the patient treats early in the attack, while the pain is still mild. This is broadly true for triptans, NSAIDs, aspirin...
When have you found the Nidra TOMAC device to be helpful for refractory restless leg syndrome?
I have one patient who found it helpful with breakthrough symptoms in refractory RLS, but was unable to get enough coverage to continue using it.
How do you taper steroids for CAA-ri?
Thank you for the question. I have treated two patients so far for CAA-ri, one biopsy-confirmed. I also reviewed the literature on the entity. An oral steroid taper over several months is recommended to reduce the chances of recurrence. There’s no established standard timeline I have found. Monitori...