Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
In a young patient with recurrent low-grade glioma s/p gross total resection, is there any role for further observation instead of radiation and chemotherapy?
As simple as this question seems to be on the surface, it is actually a very difficult clinical scenario to opine with certainty, primarily because of a lack of data. So, let us address this with each option in mind, weighing the pros and cons: Observation: We do know that in resected patients, radi...
What are red flags in an evaluation for possible multiple sclerosis that should prompt workup for genetic/inherited conditions?
Clinical red flags: Chronic, progressive course, developmental regression preceding presenting event, positive family history of similar symptoms, other organ involvement such as diabetes, sensorineural hearing loss, cardiomyopathy, GI dysmotility, rapid bilateral vision loss without other evidence ...
When is a paraneoplastic panel indicated when working up patients with neuromuscular conditions?
Is there any benefit from oral vs topical steroids in herpes zoster opthalmicus?
The role of steroids in uncomplicated herpes zoster is limited, but weak evidence suggests they may provide some symptomatic relief. However, oral and topical steroids may have a role in complicated zoster, including cases with ocular involvement/HZO, when used with antiviral therapy, especially if ...
How do you manage glioblastoma presenting with leptomeningeal dissemination?
Hospice is a very legitimate option. As physicians, we recommend this far too infrequently.
How does the presence of signs of cerebral edema influence your decision for thrombolysis and endovascular thrombectomy?
When deciding on intervention for large core strokes, the presence of cerebral edema is something I expect rather than a factor that would change my approach. The article examined net water uptake (NWU) as a potential imaging marker to predict edema progression in large core stroke. While the second...
Regarding CVST, what protocol of heparin dosing do you regularly use and does it change depending on clot burden/ICH status?
There is very limited randomized evidence for the use of anticoagulation in any form for CVST. We often rely on extrapolations from data on the acute management of DVT in the leg and pulmonary embolus. We are mainly limited to cohort studies and small RCTs. Recent trials in this area include the TO-...
Do you choose an antibiotic with CSF penetration, such as nafcillin over cefazolin, in the setting of MSSA endocarditis with septic emboli to the brain (assuming no concomitant meningitis or brain abscess)?
The prevailing theory that cefazolin has poor CNS penetration is really based on 3-4 studies performed in the 1980s (Nolan & Ulmer, PMID 7365282) where they were extrapolating data from studies looking at cephalothin concentration in CSF. Another study looking specifically at cefazolin concentration...
What is your recommended long term management of extensive dural venous sinus thrombosis in an otherwise healthy young patient?
From a Vascular Neurology perspective, there are two considerations when faced with patients with venous sinus thrombosis. First is the status of the intracranial venous circulation and whether or not there has been adequate reconstitution of venous outflow, either through recanalization or collater...
What imaging features can help distinguish between an acute versus chronic cervical internal carotid occlusion?
Distinguishing between acute and chronic cervical ICA occlusion is often challenging, but CTA and CTP can offer helpful clues in assessing lesion acuity. On CTA, contrast enhancement along the vessel wall at the site of occlusion, sometimes referred to as the "ring sign," may suggest an acute thromb...