Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What is a reasonable length of time to wait before performing a cardiac ablation for atrial fibrillation in a patient with an embolic stroke?
There is no data related to this question. If the deficits related to the stroke are mild to moderate, I would consider doing an ablation within a few weeks after an embolic stroke. With more severe deficits, I would wait longer.
What is your approach to the evaluation of minipolymyoclonus?
The term minipolymyoclonus usually describes low-amplitude arrhythmic movements of the fingers seen when the arms are outstretched, which can be seen in several conditions. The evaluation would depend on the accompanying symptoms. For example, if minipolymyoclonus is seen in the setting of weakness ...
What is the role of inpatient psychiatric or psychological evaluation in patients who have had acute function change as an inpatient?
This is an important question. An acute change in function is a frequent reason for hospital admission and must be considered as a feature of some underlying medical, neurological, or psychiatric condition. It is important to know what functions have changed, including basic and instrumental activit...
What brain imaging findings do you find reliable to help support a diagnosis of idiopathic intracranial hypertension?
In a study by Bidot et al., PMID 26457687, transverse venous sinus stenosis (TVSS) was the most useful sign of IIH because of its high pooled sensitivity (97%) and specificity(93%). Orbital findings, such as optic nerve head protrusion, posterior scleral flattening, optic nerve tortuosity, and diste...
How do you approaach ischemic stroke from suspected symptomatic ipsilateral carotid web with less than 50% stenosis?
I would need to know what the definition of "suspected symptomatic" means in this setting. Is this the patient's first ischemic event? Or have there been multiple ischemic episodes? Is the stroke pattern sub-cortical/lacunar-type from uncontrolled microvascular risk factors or cortical-appearing sug...
How do you treat a mild basilar artery occlusion stroke?
I agree with the prior post and would like to add some additional insight from the interventional lens. As mentioned, NIHSS isn’t well-suited to posterior circulation strokes. From the intervention side, basilar occlusion can look deceptively mild on paper, but the outcomes are often anything but. I...
What would be your approach to the consideration of the use of antiamyloid monoclonal antibodies for nonamnestic Alzheimer's disease with a positive biomarker for brain amyloid pathology?
Because treatment appropriateness is based on the stage of cognitive impairment, we base our evaluation on whether the patient meets criteria for mild cognitive impairment or early-stage dementia. We do not use cognitive testing cutoffs, even in amnestic Alzheimer's disease, as staging accounts for ...
Do you consider immunosuppression in patients with a history of Sjogren's disease and clinical features of inclusion body myositis?
My short answer is no. The phenotype and MRI findings described in this case suggest IBM and recently published consensus criteria for the diagnosis of IBM require only the presence of endomysial lymphocytic inflammation in muscle biopsy as a mandatory criterion, along with supportive clinical pheno...
Which patients do you find respond best to DHE nasal powder for acute migraine?
Unfortunately, I do not think that we can predict how patients will respond to any acute treatment. In patients who are naive to prescription abortive treatments in the US, we cannot predict which prescription abortive treatment will be effective, so the choice depends largely on the cost, insurance...
When should you suspect that palatal tremor could be a functional neurologic disorder?
The late Dr. Hallett and others have suggested that essential palatal tremor or myoclonus is largely functional, based upon the appropriate history of variability and entrainment, plus, in some cases, electrophysiologic data as well. As a general rule, functional disorders should be diagnosed based ...