Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you approach the management of a patient with lumbar spinal metastasis with neurologic symptoms but without evidence of spinal cord compression?
From the brief description included, it appears that the lesion is at the level of the cauda equina, a group of nerves and nerve roots stemming from the distal end of the spinal cord, typically levels of L1-L5, and contains axons of nerves that give both motor and sensory innervation to the legs, bl...
What criteria do you use to decide whether to start anticonvulsants in patients with brain metastases?
Patients with intact brain metastases in the absence of seizure activity should generally not be receiving prophylactic anticonvulsants based on 2019 guidelines from the Congress of Neurologic Surgeons subsequently endorsed by SNO and ASCO. The practice of prophylactic AEDs in the post-op setting is...
How do you time CSF analysis for suspected CNS lymphoma in patients who are on steroids?
As soon as possible. The diagnostic yield of biopsy or LP can diminish very quickly after steroid initiation. Holding steroids for 7-10 days if possible is one common strategy to try to mitigate this. If steroids are unavoidable, or if tapering/holding them is not feasible, additional strategies to ...
When is the best time to try targeted therapy in adult-type diffuse non-IDH glioma?
Has this practice changed since posted?
Does TpA or TNK cause acute post infusion severe headache with no intracranial bleed?
The short answer is yes patients can develop headaches post thrombolysis. Some report about 32-33% of AIS patients post thrombolysis experience headaches without hemorrhagic conversion. These do not seem to be associated with the increasing risk of hemorrhagic conversion. Some stroke patients develo...
How long do oscillopsia and ataxia secondary to thiamine deficiency last after completing repletion?
I treated a patient with severe thiamine deficiency following bariatric surgery. I administered parenteral thiamine at a dose of 100 mg weekly. The diplopia resolved with the first infusion, but returned 5-6 days. She was continued on thiamine infusions weekly and her diplopia eventually resolved. I...
In patients being evaluated for brain death, which abnormal movements are definitively known to still be consistent with brain death and which are possibly consistent with brain death but lack definitive evidence?
This is indeed a challenging question, one that I continue to grapple with as a neurointensivist. Fortunately, most brain-dead patients do not exhibit any movements in response to noxious stimuli, but some case series report reflexive movement in up to 75% of cases. The classic teaching is that only...
How do you medically manage acute basilar artery occlusion in patients with low NIHSS who are not candidates for EVT but at risk for deterioration?
First, I would consider endovascular therapy even with a low NIHSS, if the patient is otherwise a good candidate. If this were not possible, I would angicoagulate with IV heparin initially, then a DOAC (direct oral anticoagulant).
When would you refer patients with Parsonage-Turner syndrome for surgical treatment?
An introduction is required because this is a relatively new concept in the management of neuralgic amyotrophy.Despite historical data from the '90s suggesting that >80% of Parsonage-Turner (neuralgic amyotrophy/NA) patients will show significant improvement of motor function in two years after the ...
How do you manage AEDs in patients with malignant brain tumors?
Use of prophylactic anti-seizure drugs in patients with primary malignant brain tumors is not recommended and has been evaluated in multiple systematic reviews and guidelines including a recent systematic review and well-done guideline paper from SNO and EANO published by Tobias Walbert, Elizabeth G...