Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
When would you consider intra-arterial thrombolysis for acute ischemic stroke?
The prior answer brings up several valid scenarios where IA thrombolysis may be applicable. I can offer some nuanced perspective based on current practice. Device technology has advanced significantly since the landmark EVT trials of 2015. Today, EVT is increasingly feasible in distal-segment occlus...
How do you utilize FDG PET in the evaluation of dementias?
FDG PET is a regional map of glucose utilization in the brain. It tends to show reduced activity in specific areas in early Alzheimer's disease. It can complement MRI, which shows patterns of atrophy, rules out strokes, etc. Neither test is biologically specific for AD, which would require an amyloi...
How do you manage patients with glossopharyngeal neuralgia?
Glossopharyngeal neuralgia can be managed similar to trigeminal neuralgia (TN). It presents with pain like TN but located in the glossopharyngeal distribution (posterior part of the tongue, tonsillar fossa, pharynx, or angle of the lower jaw and/or in the ear). Note that neuralgia of the superior la...
How do you decide between using nuclear medicine scanning versus computed tomographic angiography (CTA) for ancillary brain death testing?
I would NEVER use CTA as an ancillary test when determining brain death.The American Academy of Neurology guidelines specifically classify CT angiography as an unacceptable ancillary test for brain death determination.The acceptable ancillary tests for adults include digital subtraction angiography ...
Would you avoid triptans in patients with CADASIL?
Most patients with CADASIL have migraines with aura (including hemiplegic migraine and the severe form known as CADASIL encephalopathy). There is no evidence contradicting the use of triptans in CADASIL specifically. However, smaller studies and systematic reviews, and meta-analyses have shown that ...
When do you consider long-term anti-seizure medication for patients who have an acute symptomatic seizure in the setting of a cerebrovascular event?
The question is really which patients who suffer acute symptomatic seizures are at the highest risk of epilepsy and therefore may require long-term antiseizure medication.This recent paper from Neurology Clinical Practice by Sivaraju et al., PMID 39185097 can help shed some light on stratifying thes...
How do you manage cramps in patients with ALS?
Cramps are an extremely common symptom in patients with ALS; one survey study out of Wake Forest noted 95% of their ALS patients had cramps at some point in their history (1), and my clinical population is in the similar range. Despite this, many treatments for cramps do not have a robust evidence b...
What considerations should you discuss with patients prior to genetic testing for suspected Huntington disease?
Genetic testing for Huntington disease (HD) is dependent on several factors, including age, family planning, and the genetics of family members known to have the disease. For example, if someone in the family has a known mutation in the HTT gene, and the individual you are assessing has signs of HD,...
In patients with medically-refractory left temporal epilepsy, and left dominant language and memory, how should you approach surgical intervention?
Dominant temporal lobe epilepsies are often not candidates for hippocampal ablation or anterior temporal lobectomy because the risk for memory decline is deemed to be too high. Although having left temporal lobe epilepsy does not rule out the possibility of a resective/ablative surgery, in your part...
When do you check neurofilament light chain in patients with neurodegenerative illnesses?
Neurofilament light chain polypeptide is a protein that can be released in blood or CSF during (active) injury to nerve axons in the CNS. Until recently, this was exclusively a research tool, and in the last 5-6 years we saw an explosion of publications, demonstrating the utility of this biomarker, ...