Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What behavioral interventions have you found most effective for managing self-injurious behavior in autism?
I think you'll find some good information in this related post: https://www.themednet.org/question/21993
How do you treat restless leg syndrome in patients with end-stage renal disease?
Based on the 2025 guidelines for RLS in patients with ESRD, I would recommend first checking iron studies and using IV iron sucrose if ferritin and transferrin saturation meet the criteria since the use of iron in this population has moderate certainty of evidence. If an iron infusion is not helpful...
How can you differentiate vessel wall enhancement related to CNS vasculitis versus atherosclerotic changes on MRA brain vessel wall imaging?
On MRA brain vessel wall imaging (vWI), central nervous system (CNS) vasculitis typically presents with concentric, uniform vessel wall enhancement and thickening, reflecting a diffuse inflammatory process involving the entire circumference of the vessel wall. In contrast, atherosclerotic changes mo...
What is your approach to addressing dementia-related agitation for patients living at home with family?
There is absolutely no simple way to answer that question. Even when the family is providing a very calm and nonconfrontational environment, avoiding any possible way of causing the agitation, it is virtually impossible to predict when and why a person with dementia would become agitated, angry, unp...
What would prompt you to consider a sleep study for narcolepsy in a child or adolescent with new-onset hallucinations?
It would depend on other elements of the history. The age of the child, the timing of the hallucinations, particularly if they are associated with sleep, onset or awakening, other hypersomnia disorder symptoms, and the child's psychiatric history. Generally, I have a very low threshold for an in-lab...
How do you manage a patient who has history consistent with juvenille myoclonic epilepsy (JME) but does not have the classic polyspike pattern on EEG?
They should be managed like any idiopathic generalized epilepsy (IGE), since JME is but a specific subtype of IGE. SO, broad-spectrum ASMs only.
How do you approach weaning treatments for CIDP in remission?
I usually treat CIDP patients with IVIG first, unless there is a contraindication (e.g., history of anaphylactic reaction, very recent thrombotic event, or worsening kidney function in a person who is not yet on dialysis). I use the regimen proposed by the ICE trial, with a loading dose of 2 g/kg fo...
Would you consider IV thrombolytics in patients with acute ischemic stroke, with or without a large vessel occlusion, if they have a history of von Willebrand disease (VWD), regardless of its type?
I would still consider it unless the INR >1.7 or they are on anticoagulation for some clinical reason.
Do you recommend surveillance lumbar punctures for patients with Mollaret's meningitis after diagnosis or in between clinical episodes?
No. My focus with these patients is to establish the diagnosis, which is often difficult, with false-negative CSF PCR tests, and then do everything I can to prevent and alleviate the attacks. I see no role for surveillance LPs because either the patient is better clinically or they are not, and CSF ...
When do you consider cardiac CT to evaluate for etiology of acute ischemic stroke?
I do it in place of TEE in: Patients with LVO or severe stenosis, for whom I am concerned about hypoperfusion causing another stroke. Elderly patients that may have a higher complication risk from TEE. I am mainly looking for intracardiac thrombus.