Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Do you recommend work up for POEMS and/or amyloidosis for IgM monoclonal gammopathies associated with neuropathy?
While IgM monoclonal disorders, amyloidosis, and POEMS syndrome may all be associated with peripheral neuropathy, they are not often confused with one another. A patient with a peripheral neuropathy can be diagnosed most simply by a serum protein electrophoresis. The presence of a monoclonal IgM spi...
Would a longstanding diagnosis of multiple sclerosis impact your radiation recommendations for a patient with breast cancer?
In my opinion, the simple answer is no. At least not in my experience treating one MS patient with whole breast radiation. Unlike Scleroderma, which is an autoimmune disease that can result in inflammation and thickening of the skin, connective tissues, and internal organs, MS is an autoimmune disea...
Can anti-cardiolipin or anti-beta-2 glycoprotein antibodies cause prolonged PTT in the absence of a lupus anticoagulant?
Lupus anticoagulants are a heterogeneous group of antibodies that do not have uniform activity in all assays. Furthermore, testing procedures are not well-standardized. Since relevant clotting factor deficiencies have been ruled out and the long PTT does not correct with mixing, and since there is o...
When should surgical tumor resection be considered in patients with a low-grade glioma?
In adults with low-grade gliomas, there is substantial evidence suggesting that aggressive, early surgical resection improves outcomes and survival (Jakola et al., PMID 23099483). Historically, this has been particularly true for tumors that carry an IDH mutation or 1p/19q codeletion. This survival ...
When is air travel safe for patients with recent diagnosis of ischemic stroke?
Air travel on a modern commercial jet includes full pressurization and oxygenation, such that I see minimal or no risk to air travel. Flying on a small, private plane would have higher risk, so I would wait longer for that, perhaps even a month. During helicopter flights for acute stroke patients, o...
What is your preferred site for central venous access in patients with concern for raised intracranial pressures?
Subclavian is our preferred central venous access for raised ICP, but we also utilize femoral lines for patients at high risk of pneumothorax or who need more emergent access. We have historically avoided IJ lines because of concern for impeding venous drainage by blocking the IJ. I do not think thi...
What markers on EEG can help predict/detect postoperative or ICU-related delirium?
The interest in the use of EEG for delirium prediction/detection has increased in recent years. Postoperative delirium (POD) is common and is linked to adverse long-term cognitive outcomes. Preoperative EEG biomarkers of postoperative delirium may aid in risk stratification and implementation of pre...
What are some methods you use to limit or decrease the development of post-ICU PTSD in patients?
The following strategies are employed: While in ICU: For a patient who is intubated and sedated --> limiting sedation, promoting nighttime sleep (with NAP protocols, sleep aids etc.), addressing delirium and pain, (sleep wake cycles, minimizing narcotics and benzodiazepines, etc.), maintaining awake...
How does your decision to use high-efficacy disease-modifying treatments (HET) differ, if at all, when treating late-onset relapsing-remitting multiple sclerosis?
For late-onset patients who still have evidence of active disease (gad-enhancing lesions on MRI within the past 1-2 years), I will treat with HET, such as anti-CD20 therapy. Older individuals tend to have less ability to fully recover post-relapses than younger persons. I would be more hesitant to u...
How many times one can use IVIG in GBS?
There is currently no evidence supporting the efficacy of a second dose of IVIg or the addition of IVIg after PLEX in GBS. Clinical trials investigating complement inhibitors in GBS are ongoing, although conclusive results are pending. Encouraging results have emerged from a small Japanese study. Co...