Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Do you typically obtain an EEG in patients undergoing workup for cognitive dysfunction?
I do not obtain an EEG unless something in the patient's history leads me to suspect seizures.
What leads you to consider prescribing a nasal spray formulation for the treatment of acute migraine?
Interesting discussion. From my perspective, one of the big choices in the acute treatment of migraine is whether to give an oral or non-oral treatment. Patient preference studies show that oral agents are preferred if they work so I usually start there. Most patients prefer nasal sprays to subcutan...
Would you recommend TNK or DAPT in patients with stroke-like symptoms and NIHSS less than 5 presenting within 4.5 hours?
I agree with Dr. @Dr. First Last. The decision in patients with minor stroke rests on whether the symptoms are disabling, which in general, is based on a discussion with the patient and their family to understand how the deficit could impact the patient's career or hobbies. For disabling deficit, I ...
In what clinical settings is acute ICH clot removal recommended?
Clot removal should be performed when there is a cerebellar hemorrhage with brainstem compression and/or hydrocephalus. Clot removal can be considered as a life saving measure if there is neurologic deterioration, midline shift, or depressed consciousness. There is still uncertainty about clot remov...
How do you manage patients with ice-pick headaches?
Ice-pick headaches, previously known as jabs & jolts and now often referred to as stabbing headaches, also manifest as stabbing face pain, which can be mistaken for trigeminal neuralgia due to lack of awareness. They can strike the head or the face suddenly, resembling lightning bolts. While common ...
When would you consider treatment with steroids in patients with diabetic radiculoplexus neuropathy?
Steroids (pulse IV methylprednisolone) are the only treatment for diabetic amyotrophy supported by randomized placebo controlled trial (Dyck PJB et al., Neurology 2006; 66(5, Suppl 2):A191.) The soonest the treatment is started after onset of symptoms, the best. I will treat most patients presenting...
How do you treat fatigue symptoms in myasthenia gravis?
Importantly, especially in myasthenia gravis, but also in other neuromuscular disorders, we try to differentiate between peripheral fatigue (i.e., fatigability of the muscles due to reduction in the safety factor at the neuromuscular junction leading to worsening muscular function and fatigability a...
How do you do a levodopa trial in the outpatient setting?
In a patient with Parkinsonism whom I am starting levodopa treatment for, I begin by conducting a detailed motor examination using the MDS-UPDRS III to assess baseline symptoms. Typically, bradykinesia and rigidity respond most consistently and robustly to treatment. While tremor and gait disturbanc...
What other conditions should you consider in someone with presumed Tolosa Hunt but without significant improvement on steroid therapy?
Sufficient workup should ideally be obtained before initiating steroids in order to exclude disorders that may have a similar presentation with quite a different approach to management. These investigations include but are not limited to the following: brain MRI with contrast + thin slices through t...
How do you approach a patient who develops a rest tremor after chemotherapy?
Like many questions in Neurology, this question can be simple or rather complex to answer. If the patient is felt to have a drug-induced tremor, withdrawal of the offending drug or drugs should be the first choice whenever possible. In the chemotherapy setting, a common scenario would be when a dopa...