Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Are there instances where tracheostomy alone without mechanical ventilation can be sufficient to manage neuromuscular respiratory failure?
This is a very rare circumstance in our assisted ventilation clinic. This situation usually arises because a patient underwent tracheostomy during an acute illness while they were requiring invasive ventilatory support, and were able to wean from the ventilator but had dyspnea or hypercarbia while t...
Do you always initiate hypercoagulable work up in a patient with recurrent stroke?
As always, this is a more complex problem than it appears. A history of both prior other thrombosis and family history of thrombosis is essential. Are there good reasons for the stroke and/or has it been worked out in past including carotid disease, atrial fibrillation, underlying malignancy, valvul...
How will you treat a young man with recurrent cryptogenic strokes with no identifiable cause, with MTHFR A1298C homozygous mutation and normal homocysteine level?
The genetic variant you report seems to be a SNP that, while it has been reported to be statistically associated with various diseases in GWAS studies, is not pathogenic. SNPs that are significant in GWAS studies have very small effect sizes that can be measured when considered in thousands of peopl...
What is your preferred imaging modality for determining infarct core when evaluating acute stroke cases?
MRI is the best imaging modality for determining core infarct, but non-contrast head CT and CT perfusion imaging are more practical and faster, so they are used by a vast majority of centers. I use CT and CTP because they are much faster to obtain at my institutions.
How do you decide between the gene silencing drugs for familial amyloidosis with polyneuropathy?
The data to answer this question are very limited to non-existent, exactly because there have been no studies with a head-to-head comparison of the efficacy of different agents. Ultimately, it's a shared decision between the patient and the physician, which should take into account factors such as p...
How do you use optical coherence tomography in the diagnosis and management of patients with multiple sclerosis and related diseases?
Personally, I do not routinely obtain OCTs, but I always find them helpful. Most of my patients who have had optic neuritis tend to have them yearly under the care of their ophthalmologist and I review them for stability. One could argue that these should be done annually along with MRIs for all pat...
What is the best approach to treatment for cenestopathies (sensation of electric current in patient's brain) accompanied by anxiety and inability to sleep?
Thank you for your question. Cenestopathies (referring to the feeling of being ill and this feeling not localized to one region of the body) may not be the correct term for this interesting phenomenon, commonly called "brain zaps". Brain zaps are a poorly understood symptom of antidepressant withdra...
Do you routinely perform muscle biopsies in patients presenting with the classic symptoms of Inclusion Body Myositis along with positive CN1A antibody?
YES. There are new consensus guidelines from ENMC about the diagnosis of IBM (Lilleker et al., PMID 38522330). They define the clinical presentation of IBM as typical (age >45, progression over >12 months, long finger flexor weakness > deltoid weakness, quadriceps weakness > hip flexors), or atypica...
Which methods of tracking response to treatment in myasthenia gravis do you find most helpful?
To me, it is still a combination of history and clinical examination supplemented by MG-specific scales. Thus, it is the global impression of how a patient is doing rather than any one metric. Amongst the MG-specific scales, I use the MG activities of daily living (MG-ADL) and MG Composite (MGC) sco...
What is the stepwise investigation of patients suspected of inflammatory myopathy?
I have published an algorithmic approach to suspected inflammatory myopathy in Continuum Lifelong Learning in Neurology from AAN (Manousakis, PMID 36537973). Unfortunately, the article is not free, and I can't attach the algorithm in this response, because it's a PPT file. Happy to provide it upon r...