Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
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...
How do you use Boswellia for radiation necrosis?
I reached out to my colleague, naturopath Lise Alschuler, Associate Director of the University of Arizona Fellowship Program in Integrative Medicine program, for her thoughts on this question. Here is her answer:This study by Upadhyay et al. is a well-designed study which builds upon earlier studies...
Do you routinely obtain a biopsy of a presumed meningioma prior to SRS to confirm grade 1?
There is an emerging and growing body of data using various AI tools and radiomics analysis, as well as the incorporation of advanced imaging, that aim to improve the ability to predict the grade of meningioma. Most of this work remains "limited institution" in terms of applicability. In the current...
How do you treat agitation in progressive supranuclear palsy?
Benzodiazepines are generally avoided due to adverse effects on cognition, the increased risk of falls, and disinhibition.Pharmacologic treatment for agitation is generally reserved for patients with severe agitation, when a patient is a threat to themselves and others, when agitation is the cause o...
What is your approach to tapering anesthetic drips for refractory status epilepticus after achieving burst suppression?
Ensure adequate oral/IV ASMs are on board, targeting the receptors appropriately based on the type of status- generalized, focal (e.g., GABA, Na channel, glutamate, etc.). These would include the first, second, and third line as per status protocols. Check levels to ensure adequacy. At least 24 hou...
What factors do you take into account when deciding the length of adjuvant temozolamide in GBM?
The field is evolving from 12 cycles to 6 for IDH-wildtype GBM in recent years, on the basis of some retrospective studies and notably the prospective Spanish study GEINO 14-01 - there does not seem to be much OS benefit, and there are also toxicity concerns (myelosuppression, hypermutation). Extens...
How often do you perform surveillance brain MRIs in patients with MS on highly effective DMTs?
The so-called guidelines to do MRIs on an annual basis pre-dated the introduction of anti-CD20 drugs. After these drugs were introduced in 2017, the need for MRIs has fallen off a cliff (as it ought to). With 95% or better suppression of new disease activity (inflammatory component and not the iron...