Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How does APOE4 status affect your clinical decision-making in patients who may be eligible for anti-amyloid therapies for early Alzheimer's disease?
Studies of anti-amyloid therapies show an increased risk of ARIA, both inflammation and bleeding, in patients homozygous for APOE4. This risk is too high to justify the small benefit of these therapies in slowing cognitive deterioration.
Do you ever use ocular ultrasound in evaluation of papilledema?
As a neuro-ophthalmologist, I never use ultrasound to make a diagnosis of papilledema. I do use it to reveal optic nerve head drusen that also cause axoplasmic flow stasis and can mimic papilledema. A high quality set of fundus photos is very useful for determining the presence of optic disc edema.
Do you recommend CT perfusion in patients presenting with symptoms of acute stroke before 6 hours?
Routine CTP is not required in the <6 hours according to the AHA/ASA guidelines. The TENSION large core data would also support not requiring CTP in the early window.In the >6-24 hour period, the MR CLEAN-LATE trial, which was based on patients with CTA collaterals selection, showed favorable outcom...
When do you consider stenting in patients with recurrent stroke with ICAD?
I agree with the answers mentioned above. Additionally, I ensure that the patient has made diligent efforts to address modifiable risk factors, with smoking cessation being of utmost importance, along with medication compliance. The specific area of stent placement and the type of stent used may var...
How do you counsel patients who wish to travel to high altitudes with myasthenia gravis?
It can be a challenge as high altitude can unleash fatigue, shortness of breath, increased weakness, etc. In a myasthenic patient, it is important to recognize this as some of the symptoms may resemble myasthenic exacerbation acutely. Counseling patients on optimal control of generalized myasthenia ...
What antibiotics would you use for empiric treatment of a brain abscess in patients allergic to penicillin, metronidazole, and vancomycin?
Linezolid/Bactrim/Ceftaroline?
Do you avoid triptans in patients on SSRI's due to the potential risk of serotonin syndrome?
I feel very comfortable using triptans with SSRIs/SNRIs. In 2010, the American Headache Society released a position statement on this very issue:Evans et al., PMID 20618823Their position is that the available evidence does NOT support the claim that triptans should not be used with SSRIs or SNRIs.A ...
Should follow-up imaging for unruptured intracranial aneurysms include MRA head and MRI brain to evaluate for arterial wall enhancement?
I prefer CTA to assess asymptomatic intracranial aneurysms if there are no concerning morphological features (e.g., daughter-sac, bi-lobed, or dysplastic/irregular shape) and if the size is less than 5 mm (although size/rupture risk can vary depending on the location of the aneurysm). CTA is easier ...
Would you use sumatriptan in a patient with a history of cerebral aneurysm rupture?
Yes. There is no evidence that the use of triptan in patients with an unruptured cerebral aneurysm, or in those who have a history of ruptured aneurysm that have been coiled or clipped, increases the risk of serious adverse events. I would not use them in the setting of acute subarachnoid hemorrhage...
How would you manage a local recurrence of a spinal hemangioblastoma following prior surgical resection alone?
Hemangioblastomas are benign rare tumors that arise from the linings of blood vessels (embryonically arrested hemangioblasts) and can form in the brain, spinal cord, and retina. When they occur in the spine, they have a tendency to recur ~25% of the time. The primary treatment for a recurrent spinal...