Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What is the clinical utility of getting repeat antibody testing in patients with recurrent symptoms and a history of Miller-Fischer syndrome?
The treatment of MFS is controversial and not addressed in the recently published guidelines. Should a patient exhibit muscle weakness beyond facial and EOM, it could imply an overlap between MFS and/or GBS. While there's limited study in this area, persistent antibodies, albeit reduced, might not s...
Is there a concern for the potential of future congenital malformations in offspring when preservation of eggs and sperm is done AFTER cyclophosphamide treatment given that it is an alkylating agent?
No, there is not a significant risk of congenital malformations in embryos created with cryopreserved gametes or unassisted pregnancies AFTER cyclophosphamide use. While alkylating agents lead to both male and female infertility, congenital malformations from cyclophosphamide occur when conception h...
What are the current treatment options for progressive multifocal leukoencephalopathy in patients without HIV/AIDS?
It depends on the underlying cause of the immunodeficiency that led to the PML. In cases of natalizumab-induced PML, this would involve stopping the drug immediately. There is controversy over whether or not to perform plasma exchange to hasten this. In some cases, this has provoked IRIS while in ot...
Are adults with IDD at increased risk for adverse events like NMS or central anticholinergic syndrome?
Thanks so much for your question. There is no doubt that individuals with IDD may often exhibit aberrant behaviors including those with autism. The use of various psychopharmacologics is very prevalent. The risks of side effects and particular complications is certainly higher in this cohort. Check ...
How would you interpret a temporal artery biopsy demonstrating focal chronic inflammation in the adventitia associated with small adventitial vessels and nerves without inflammation of the intima and media and without giant cells?
Peri-adventitial inflammation seen in temporal artery biopsies is generally a non-specific finding. This was demonstrated nicely in a recent histopathological study from Mayo Clinic evaluating temporal artery samples from autopsy cases. Over 40% of temporal arteries from older individuals (with no h...
At what point is a skin biopsy indicated in patients with neuropathy?
Skin biopsy is indicated when small fiber neuropathy is suspected- that is, a patient with usually painful paresthesias- positive sensory symptoms, and less often negative sensory symptoms alone, and normal EMG/NCS. Clinical exam usually, but not always, will show some signs of small fiber involveme...
Is there a role for intravenous temozolomide in place of oral for the 5-day dosing q 28 days after surgery/XRT+Temozolomide for glioblastoma multiforme?
I have never used IV temozolomide, or seen it used by others in practice for GBM, and do not think it would offer a significant benefit over oral formulations as it has high oral bioavailability. I have seen and prescribed liquid oral temozolomide for patients with dysphagia.
How do you work up incidentally found papilledema in the emergency room?
The term "papilledema" should be reserved for optic disc swelling due to increased intracranial pressure - but I assume that this question is asking what to do if the fundus examination looks abnormal (blurred disc margins perhaps) when there are no visual symptoms or symptoms of increased intracran...
When do you consider nerve blocks for headache management in patients admitted to the neuro-intensive care unit with subarachnoid hemorrhage?
For aneurysmal SAH, I try different medication combinations for the first 5-7 days. After this time frame, if headache pain is still severe and/or the patient uses opioid meds too frequently, I request an occipital nerve block from our pain management team. In my experience, about two-thirds of pati...
Do you repeat a lumbar puncture in a patient living with HIV diagnosed with and treated for neurosyphilis and if so, when?
This is a complex issue, and there isn't a one-size-fits-all approach. There are no hard and fast guidelines in place. If the initial CSF abnormalities include only reactive CSF VDRL, along with modest protein elevation and mononuclear pleocytosis (both of which are consistent with HIV infection), a...