Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
When should we order a DaT scan in patients suspected of Parkinsonism syndrome?
I believe that a good clinical examination can tell you if a patient has parkinsonism or not and that is the same answer one gets from a DaTscan. If the findings are too subtle, then re-examine the patient at intervals. So my answer is it is not necessary. I emphasize "my" answer because not everyon...
What are your recommendations for screening for sleep disorders in patients with IDD?
Sleep disorders are very common for people with IDD. One consideration, in particular, is in patients with Down Syndrome because of the shape of their mouth and large tongue. They have a very high rate of sleep apnea, obstructive sleep apnea in particular, which can be seen even in children. You wo...
Does global brain atrophy increase risk for intracranial bleed after fall in older adults?
It depends on the location of the hemorrhage. Subdural bleeding/hematoma is much more likely in elderly people with brain atrophy and a fall. Epidural hemorrhage is much more common in young patients. Intracerebral hemorrhage is more related to risk factors such as hypertension in middle age and amy...
Do 5HT4 agonists such as Metoclopramide actually lead to improvement in symptoms for patients with diabetes related gastroparesis?
Yes, sometimes when the gastroparesis is frequent or the symptoms are tough, I do use Reglan to help. By the time they wind up in the hospital, they are really willing to have me use anything on them that might help. I explain to every patient the side effects of Reglan, including tartive dyskinesia...
What is the role of inebilizumab in the maintenance treatment of IgG4-related disease?
Inebilizumab may play an important role in the maintenance treatment of IgG4-related disease (IgG4-RD), particularly in patients at high risk for relapse. These are typically patients with multi-organ involvement and elevated serum IgG4 levels who initially respond well to corticosteroids but tend t...
What MRI findings would you consider compatible with an acute seizure or seizures?
Frequent seizures and status epilepticus can result in reversible neuroimaging findings such as cortical enhancement, DWI cortical ribboning, and decreased attenuation on CT. Imaging findings can be resolved with control of seizures.Hormigo et al., PMID 15023812Kramer et al., PMID 3653056Riela et al...
What serum biomarkers are most helpful in cardiac arrest prognostication?
Neuron-specific enolase. This is checked at 24, 48, and 72 hours. It is, however, NOT to be used in isolation for prognostication, which is multimodal, including clinical exam after clearance of sedation (typically at 5 days post arrest), EEG (e.g., looking for reactivity of background), NSE, and MR...
How do you determine if generic vs. brand formulation of a DMT is the probable cause of worsening multiple sclerosis disease activity?
I based this on the timing of the switch to generic formulations and the duration of stability on brand formulation. For example, if a patient has been on brand DMT with stability for 5 years, then recently changed to generic with disease activity within the first year, I would consider that the gen...
Would you recommend muscle or nerve biopsy in a patient with amyoplasia congenita?
No, I would not for at least 2 reasons. The probability of getting a quality sample is very low, and it is most likely that no muscle would be obtained as the name of the disorder implies (amyoplasia). Furthermore, the likelihood of finding a genetic cause for this is VERY low. In fact, in using WES...
What is your approach to Tardive Dyskinesia when VMAT2 inhibitors are ineffective or unaffordable?
In established cases of tardive dyskinesia, in which withdrawal-emergent dyskinesia has been ruled out, and dyskinesia has persisted despite a sufficient washout interval after removal of the offending agent, VAM2 inhibitors such as valbenazine and deutetrabenazine are used for pharmacotherapy. If t...