Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
In what clinical situation would you consider using benzodiazepines in patients with dementia?
I would avoid long-term benzodiazepines treatment if someone has full-blown dementia syndrome or frontal lobe syndrome due to the potential of paradoxical disinhibitions along with amnestic and ataxic side effects. However, I would consider clonazepam for RBD and related REM sleep issues in dementia...
Would you recommend PFO closure in patients >60 years old with presumed paradoxical embolism as their mechanism of stroke?
Technically, based on the available clinical trial evidence, PFO closure is not indicated for patients over age 60 or for patients whose stroke was > 6 months ago. However, we frequently need to extrapolate from clinical trial populations to manage the patients we see in practice. Also, presumably, ...
What is the expected timeframe for the development of radiation myelitis and therapies that have helped with neurologic symptoms?
The incidence and the timeframe of the development of radiation myelopathy are influenced by total radiation dose, radiation dose per fraction, time between courses of radiation, and associated chemotherapy or immunotherapy. Older age, the presence of diabetes, and previous exposure to radiation are...
Have you found sphenopalatine blocks to be an effective treatment for headaches secondary to subarachnoid hemorrhage?
Anecdotally, yes, but we have only been doing this as part of a small research project at our institution. The literature is largely limited to case reports and there is at least one clinical trial (NCT07116408) looking specifically at this, scheduled to finish enrollment in 2026. There are commerci...
How long would you continue chronic transfusion therapy for adult sickle cell patients who have had a stroke?
Management of stroke in adults is not informed by the data that is available for children. Assuming that this was not a hemorrhagic stroke and that there was no moya-moya, I would continue transfusions indefinitely. To slow iron accumulation, I would use an exchange transfusion aiming for an HbS lev...
How do you manage autonomic symptoms in patients with myasthenia gravis?
MG is a pure motor syndrome. Patients should not have any autonomic symptoms unless they have LEMS (dry mouth) or if it is medication-related (e.g., Mestinon’s SE includes excessive salivation, sweating, and GI hypermotility). Thus, if a patient with MG has autonomic symptoms (unless explained by LE...
Which non-pharmacologic treatments for neuropathic pain have you found most effective?
I am dual-boarded in neurology and pain medicine. This question is non-specific, and therefore, none of the above is correct. Neuropathic pain is not a specific diagnosis and therefore it does not have a specific treatment option. The answer is to please see a board-certified interventional pain phy...
Is the p-tau217 plasma test used as a surrogate for amyloid PET scan or CSF testing when considering starting Leqembi in patients with Alzheimer's disease?
P-tau127 is an excellent surrogate for amyloid, though it is not yet standard practice. Currently, there are no best practice guidelines on whether p-tau217 alone is sufficient or if it needs to be combined with Aβ42/Aβ40 or APOE4. These are available clinically but not yet FDA-approved. The FDA-app...
When do you consider thrombectomy for patients with LVO and carotid dissection?
In most situations, unless there is no deficit, NCCT shows ICH, or CTP shows no significant penumbra. Dissection in itself is not a contraindication to thrombectomy.
How well does a negative non-contrast MRI of the brain exclude metastasis in a patient with squamous cell carcinoma of the lung?
I don't think the question has enough information to give a good answer. For example, if it was a T3, N2 NSCLC, or a small cell, then "yes" I'd repeat the MRI with contrast. On the other hand, if it was a T1, N0 NSCLC, then "no", I wouldn't. In other words, if I thought there was a real risk of havi...