Neurology
Questions discussed in this category
Would your management be different if the LVO was found on imaging without preceding associated symptoms?
For example, a patient with 100 WBCs in CSF with a peripheral WBC 43k/mm3 due to AML.
Specifically, headaches thought not to be related to increased ICP.
In light of data from Chang et al in J Neurol Aug 2024 showing that biomarkers such as LDH and troponin were associated with adverse clinical outcomes...
E.g., patients with small CNS mets without vasogenic edema or symptoms. Epidural disease without epidural spinal cord compression or asymptomatic low-...
Marí-Bauset et al., JCN 2014
Which factors would influence your decision?
How do you decide if and when to send patients with AChR+ ocular myasthenia gravis for thymectomy?
Can you explain when would you consider light chain amyloidosis work up with fat pad biopsy?
Especially in an inpatient setting when EMG is not immediately available.
Do you favor specific medications or surgical interventions?
Typically, neurologists were taught to treat with triptans at the onset of headache pain. Do you still follow this teaching, or do you treat at the on...
In light of the publication by Ganesh et al., PMID 39503052.
Does APOE4 status have any impact on how you would choose between lecanemab vs donanemab?
In light of the publication in Bril et al., PMID 39506903.
When do you use specialized panels for neuropathy? Which panels do you typically use?
Are there any clinical trials underway to study additional therapies?
I have seen targeted therapies used (and studied) more often in the recurrent setting. However, there may also be some rationale for trying BRAF/MEK E...
If so, how long do you continue medication and when do you discontinue? Does treatment with surgical resection versus radiation alone change your mana...
Is there a role in adjusting the medication doses to levels in seizure-free patients; or is it sufficient to just monitor patients clinically?
In light of the publication of results from the EPISODE study.
How is it that I'm able to prescribe medications to patients (in my state) via legitimate mail order pharmacies that are located in a different state?...
How long do you monitor before re-treatment or moving to another agent like IVIG?
Have recent trials (TRAIN trial and HEMOTION trial) influenced your approach?
In light of the STOP-CAD study
Would you consider charging a small fee for managing C-2 prescriptions between appointments instead of requiring the patient to come monthly?
Labs with normal PT, but prolonged PTT (47 sec, ULN 40 sec) that does not correct on immediate mix. Lupus anticoagulant negative (DRVVT and hexagonal ...
It seems clear that longer monitoring yields more AF detected. What is less clear to me is whether all ILR-detected AF is relevant and merits anticoag...
Would having infarct expansion during hospitalization change your approach?
In patients who have decreased arousal after ischemic stroke, do you use amantadine or modafinil to aid with wakefulness and interaction with therapy ...
Do you generally recommend anti-diarrheals, dietary modifications, or consider this an unacceptable side effect and move to other therapies?
A large stroke in cortical regions might have a low NIHSS, while a small internal capsule lacune might have a large NIHSS. ICH risk is thought to be a...
Would you recommend left atrial appendage occlusion with or without continuing anticoagulation? In light of Maarse et al., JAMA Neurology 2024.
In light of a recent publication by Sun et al., PMID 39235816 on the BASIS trial for balloon angioplasty for ICAS.
What criteria do you use to distinguish tumefactive MS from non-tumefactive MS?
Is it dependent on which DMT the patient is on?
Would your approach differ through telemedicine for small ERs without access to onsite ophthalmology or neurology?
In light of recent publication by Bsteh et al., PMID 39197111 that examined the outcomes in the treatment of RMS based on isolated MRI findings.
In light of the INSPIRES trial publication.
In light of the publication by Macías-García et al., PMID 39102249 on combined physiotherapy and cognitive behavioral therapy for functi...
In light of the recent publication by Menon et al., PMID 39079067 regarding the risk of converting to generalized MG as related to use of immunosuppre...
How would you adjust statin therapy in these patients?
How do you counsel patients about any potential risk?
In light of a publication by Sakusic et al., PMID 39102615 suggests an increased risk of ICH expansion in patients with heparin bridge compared to sta...
Blood pressure targets for ischemic stroke and intracerebral hemorrhage are described in several guidelines. However, in patients with acute stroke wh...
In light of a study by Caroll et al., PMID 38820488 on epidural blood patches for patients with headaches attributed to SIH that were non-conforming t...
Would you adjust your approach based on the infarct size, symptom severity, or stroke etiology?
Is there any concern for drug interactions of DMARDs and/or biologics with anti seizure medications?
Thrombophilia testing, including JAK2 is negative. When would you stop anticoagulation?
If not, are there any serum or CSF tests you consider to be helpful?
How do you balance between having a higher long-term blood pressure to prevent flow failure and leading to worsening of stenosis or occlusion from the...
Peripheral nerve surgical decompression, i.e., "migraine surgery" is a controversial procedure mostly being advanced by plastic surgeons. The evidence...
How do you counsel them on the risk?
In patients with average of less than 5 respiratory events per hour, adequate sleep duration and hygiene confirmed on sleep log, absent cataplexy and ...
E.g., a patient with newly diagnosed CIDP who is wheelchair-bound.
Is a biopsy or EMG helpful in confirming the etiology? What is the best treatment for sarcoid neuropathy?
E.g., nasal, rectal, buccal.
In light of commercially available SYNTap CSF testing.
Does this ever prompt you to change DMTs?
Should some patients get 325 mg instead of 81mg at least for a certain amount of time, such as patients in the acute phase of ischemic stroke or patie...
If yes, if the assay shows they are a non-responder, do you switch to ticagrelor?
Considering the short half-life, at what point would it be deemed too late to administer any reversal agent, and to consider withholding it?
How would you counsel the patient given the drug interactions present?
How do you guide what contraceptive type when asked by the medical team?
In light of ANNEXA-I RCT results: Connolly et al., PMID 38749032.
Are there specific mass features that would influence your treatment decision?
Patients often see a dietician at ALS centers, but what do you discuss with patients before they have a formal consult with a dietician?
In light of TIMELESS and TRACE-III trials.
In which intervals do you increase the dose and what is the maximum dose you usually try (before considering levodopa to be ineffective in the particu...
Are there specific safety concerns or long-term risks that should be accounted for when considering drug holidays or overall treatment duration?
How will you implement response assessments in patients starting tovorafenib given potential for pseudoprogression vs true progression?
Is it merely another option to try or will it become the standard choice for patients experiencing relapsed/refractory disease?
I’ve seen literature supporting use of IV pulse dose steroids, though I’ve noticed some have come up with their own various oral regimens ...
If so, what is the typical duration?
E.g., PEG tube placement.
What dosage do you start with?
Is there utility when classic inflammatory markers (ESR,CRP) or disease specific markers (C3, C4, dsDNA) do not correlate with patients disease activi...
In light of new findings on the efficacy of continuous subcutaneous levodopa-carbidopa infusion (Espay et al., PMID 38499015).
Question asked in light of Langer-Gould et al., PMID 38507657.
For example, in the setting of TBI, how do you guide the duration of the medical treatment?
Would you consider using cilostazol instead of antiplatelets?
I found a study in which 32 patients continued on Botox for the treatment of chronic migraine. Only one had a miscarriage at 9 weeks and the rest seem...
Does it influence your choice of antithrombotic therapy? Do you perform serial follow-up imaging?
In light of meta-analysis data showing favorable outcomes in this normally excluded subset of patients (Katsanos et al., PMID 37775318).
Is there management guidance on when to start after stroke onset?
When would you consider using anticoagulation and for how long?
I am aware that the radiological signs can be subtle or overlooked, or confused with a Chiari malformation, hence, I will typically review images with...
What is your strategy for treating persistent headaches in the aftermath of subarachnoid hemorrhage?
Does your strategy change depending on whether or not it is a secured or unsecured aneurysmal SAH?
Does your approach differ if the stenosis is symptomatic or flow-limiting?
Do you treat this similarly to IDH-Wildtype GBM with the STUPP regimen? Is there any role of less-intensive paradigms, such as 59.4 Gy/33 fx?
In light of the growing list of options with daxibotulinumtoxin. A receiving FDA approval in August 2023.
Individual times in the therapeutic range while on VKA treatment was not registered in FRAIL-AF.
If a patient progresses from discrete episodes (hours long) of mild vertigo with rare headaches, but associated migrainous features (photophobia and n...
Is there any evidence supporting the use of heparin boluses?
Particularly the increased risk for ALS in patients with DM in East Asian populations: Vasta et al., Neurological Sciences 2021.
The ASH 2020 guidelines have "recommended that adults with HbSS or HbSβ0 thalassemia be screened at least once for silent cerebral infarcts even ...
For example, a patient who is already on botulinum toxin injections, CGRP inhibitors, as well as an SSRI. Are there any new treatment modalities avail...
Is there a role for adjuvant chemotherapy or radiation?
Does the number of bands matter in making the diagnosis? Does it make a difference whether isolated or also in the serum? How do you interpret other r...
If so, how long would you hold? This medication is given for migraines as q3 month infusions and some data suggest that CGRP plays a role in immune-mo...
Would the management change if there were complications with optic neuritis?
In light of the evidence associating cerebral amyloid angiopathy (CAA) with subdural hemorrhage; Rivier et al., PMID 38147345.
In what clinical scenarios do you utilize post-cardiac arrest targeted temperature management (TTM)?
In the span between the HACA trial and the Targeted Temperature Management in Out-of-Hospital Cardiac Arrest study (Dankiewicz et al., PMID 34133859),...
Will you still favor starting with steroids and traditional immunosuppressive agents, move IVIG earlier in your treatment strategy, or start with IVIG...
What are the sources for this and are they reliable by today’s standards? Numerous case series report various abnormal movements but how reliabl...
Visual aura is commonly described as a scintillating scotoma. In practice, there is a much wider spectrum of visual symptoms in the migraine populatio...
If yes, is there a preference with MRI or CT technique?
Does the approach differ if the tremor stems from essential tremor or Parkinson's disease?
Do you recommend adjuvant chemotherapy after radiation treatment?
E.g., a patient has an intracranial hemorrhage after TBI with convulsive status epilepticus.
Are there emerging biomarkers that help distinguish the phenotypes in the absence of evaluation over time?
I.e., 20 minutes vs 30 minutes vs 1 hour.
How would you treat it?
Short-term glucocorticoids are often prescribed as "bridge" therapy to avoid ER visits. What else should we consider?
With the recent publication in IJROBP showing a greater than 50% response rate, have you started integrating this into your practice?
How does the 2HELPS2B scoring tool play a role in your decision-making?
Do you ever allow patients to receive a couple of cycles of systemic therapy first if there is high burden of disease? What is the maximum time after ...
We have seen 81 vs 162 vs 325 mg up to 1300 mg.
How about a distal occlusion? The patient was initially symptomatic but symptoms improved or mostly resolved.
E.g., JC virus antibody titer, absolute lymphocyte count, etc.
Plasmapheresis first or IVIG first in GBS? What other treatment options are there for severe disabling GBS?
Will these results change your practice?
What is the harm of waiting for another recurrence after a second GTR to delay the toxicity of radiation and chemotherapy? The patient is a woman <...
In patients with chronic migraine and possible medication overuse headaches due to chronic narcotic use, what’s your strategy for those patients...
Are there variations with different patient populations?
These are new medications and, to my knowledge, there is no agreed-upon standardized approach as to when they should be used.
While some have the practice of 90 days per SAMMPRIS trial, the lower rates of ischemic stroke in the medical therapy group were driven by events with...
The patient is on mesalamine for Crohn’s and CellCept and HCQ for skin manifestations (currently on hold during workup). The infectious workup i...
This is not an infrequent finding in outpatient neurology practice, often in the absence of any lacunar disease in the typical regions, though I usual...
The patient returned with recurrent subjective sensory or motor deficits. The initial GQ1B was >1:6400. Two years later, GQ1B was 1:3200.
In FRAIL-AF, switching VKA therapy to a NOAC was associated with higher risk of bleeding in elderly, frail patients.
How should IVIG and either biologic injections or infusions be spaced?
In a patient with metastatic cancer to the lumbar spine and epidural disease on CT who presents back pain and leg weakness:
Is a whole spine MRI in...
The tremor fluctuates and can last for 45 minutes with the inability to talk, eat, or drink.
Given the risk of elevated ICP, would you attempt a brain MRI to further characterize the lesion? Or would CT imaging suffice prior to intervention?
In FRAIL-AF, participants were switched from VKA to dabigatran, rivaroxaban, apixaban, and edoxaban.
Particularly when ondansetron and taking it with food are not beneficial.
Should MTCTA be standard for anyone with LKN>=6h?
Per 2021 GCA Vasculitis Guidelines: low evidence, but conditional recommendation for CTA neck, chest, abd/pelvis. Is anybody following this or do you ...
Do you feel the study outcomes are clinically meaningful?
Would you continue KEYNOTE-522 neoadjuvant therapy? The patient has a PMH of sarcoidosis with no stroke risk factors. No residual deficits.
MRI Orbits with possible mild enhancement of unilateral CN3; Brain MRI chronic microvascular disease, mild atrophy.
Do all patients with brain metastases get started on anticonvulsants?
Do you decide based on extent of edema, tumor size, or something else?&nb...
What workup do you typically recommend?
Presuming failure/intolerance of steroids, MMF, azathioprine, maintenance IVIg
Traumatic brain injury
Can this guide further treatment/prognosis?
Do you see utility in trending serum neurofilament light chain levels or any alternative screening methods beyond MRI to help identify amyloid-related...
Are there patients in whom you would specifically avoid this class of treatments?
What is the utility of it?
Do you treat with only an IV steroid pulse or do you use an oral steroid taper as well? How long of a taper do you typically use?
How would you treat a patient with necrotizing myopathy with positive anti-HMHCoR Ab (and low TIF1 gamma) that failed prednisone + Cellcept, IVIG + Ce...
Is there diminished radiotherapy efficacy in tumor control after certain timeframe has passed for malignant meningiomas with no signs of recurrent dis...
Are higher levels of exercise in patients with PD potentially even more beneficial to brain health?
See Benbadis, AAN Commentary February 2023; 13 (1).
What are the diagnosis and treatment for hypnagogic shooting headache?
Many recent studies cast doubt on continuous vs repeated routine EEG.
Do you utilize rituximab or any other specific management strategies?
For example a 1 or 2 mm brain metastasis? Would you consider waiting for these to enlarge slightly for reasons such as more certainty they are real, l...
Are there any environmental exposures you ask about for newly diagnosed ALS patients?
Current guidelines (AHA, ESO, etc.) are not clear. In addition, if a patient arrives with BP>240 how do you balance the risk of hypoperfusion with ...
Fibrinogen level >200.
Also how would you manage this perioperatively?
For patients with ischemic stroke status-post decompressive hemi-craniectomy, when should they start aspirin for secondary stroke prevention? POD 5? P...
In addition, what formula do you use to calculate the IgG index?
If a patient is has GERD or avoids NSAIDs, do you avoid Ketorolac IV?
B5 deficiency can be seen in patients with burning feet syndrome, do you typically screen for this when assessing for neuropathy?
Are there any diagnostic tests or imaging that you recommend?
How does this strategy change depending on the acuity or chronicity of the symptoms?
There are some data supporting the use of IV lidocaine as an abortive treatment for migraine, NDPH, and some trigeminal autonomic cephalalgias, when d...
Would you anticoagulate if this screening is negative pending PFO closure?
The patient has no known history of autoimmune disease.
Which genetic/other testing should be considered in an early-onset dementia work-up?
How does pravastatin differ in advantage from other high-intensity statins?
Do you distinguish between primary and secondary prevention? Wilson et al., PMID 31130428 is helpful, but curious how people apply this data in practi...
Do all malignant posterior fossa infarcts need sub-occipital craniectomy or are there a subset of cases that can be managed with EVD?
How do you differentiate symptoms related to centralized pain syndrome from possible cognitive dysfunction?
In a patient who is already on a standing regimen of baclofen, tizanidine, trihexyphenidyl, clonidine, and diazepam and who is taking additional diaze...
If so, what is the recommended maximum dose of clozapine for PD patients?
Are there any instances where you would prefer a biosimilar rather than the reference product?
Do you attempt to taper fully or maintain at a low dose?
This applies to using EVD either in addition to or instead of a large volume lumbar puncture.
Anecdotally, the diagnostic yield in these patients seems quite low, yet autoimmune encephalitis is often invoked in such patients, particularly in th...
Which tests do you typically order?
What do you recommend for surveillance and when to start the “three R’s” (riluzole, radicava/edaravone, and relyvrio (sodium PB/TUDC...
If a patient has a metastatic lesion in close proximity to one hippocampus, would you offer sparing of the contralateral hippocampus? Do your dose con...
If the patient is in burst-suppression once EEG is connected, how long do you keep patient in burst-suppression before weaning sedation?
If a patient has classic TM symptoms but a normal MRI, are there specific causes you look for?
Is your approach different than that to a primary essential tremor?
Regimen currently 25 mg lenalidomide D1-21 of D28 day cycles, Daratumumab 16 mg/kg every 2 weeks.
History of 4th ventricle choroid plexus papilloma s/p GTR, now with recurrent disease in the 4th ventricle and the left lateral ventricle (7 nodules i...
For patients who are unable to have complete brain stem testing, would you recommend apnea testing prior to ancillary tests in case of suspected brain...
How would you educate Parkinson's patients about the benefits of exercise based off of this study?
For patients undergoing outpatient MR imaging for other indications who have instantly found acute stroke, do you typically recommend the patient be a...
How does 1p/19q co-deletion and IDH mutation status influence your decision?
Do you offer this person a vascular intervention (i.e., CEA or stenting)?
Or love to share personal experiences/articles?
For example, patients with spasticity due to hypoxic or anoxic brain injury.
In what ways, if any, does the timing of perfusion imaging from onset of stroke symptoms affect its utility in informing quality of distal perfusion?
For instance, if the patient doesn’t tolerate apnea testing, is too unstable to go for ancillary testing outside the ICU, and TCDs/EEG are unava...
Do you charge for it? Do you bring them in to complete the paperwork? Or do you send them to PT for Functional Capacity Evaluation?
Do you switch MG patients from Soliris to Vyvgart due to cost, and with switching do you have a recommended wash out period?
When do you consider observation?
Do you wait 12 weeks for confirmation to begin treatment if patient is declining?
Would you consider empiric SRS if biopsy/resection is not feasible?
When would you consider liquid biopsy?
Are there any protocols in place? Aside from telling patients to use ice packs or bags or immerse hands/feet in ice water baths from 15" before to 15"...
Is there any role for a surgical intervention in patients with distal weakness, who has marked peripheral neuropathy but also lumbosacral radiculopath...
What is the best way to treat late onset myasthenia gravis (in this case, age >90)? Would the newer complement inhibitors be safe? Steroids in this...
How do you account for a normal EMG/NCS in the setting of prolonged clinical symptoms suggestive of a radiculopathy? How do you explain this to patien...
Do you see improvement with treatment such as IVIG?
In patients with hx of metastatic cancer, presenting with unilateral proximal arm weakness. No checkpoint inhibitors use.
Which CSF lab...
When it seems fairly certain that this is a drug effect is it something that can just be monitored or requires a change in approach?
What is your preferred dose/fractionation following a previous course of radiotherapy?
How do you recommend titration?
For example, a patient with 2 Hz GPDs with hepatic or uremic encephalopathy.
Does timing relative to initiation of antibiotics matter?
What are some high-yield instances where triphasic waves on electroencephalogram (EEG) are more than just harmless markers of gross toxic-metabolic en...
How do you approach low IgG levels on these medications?
Assouline et al., PMID 24411632 recommend delivering 500cGy x 4 fractions = 2000cGy on days 1, 3, 8, 10. Do you follow this schedule, treat every othe...
What modality do you prefer?
Should one restart lamotrigine or look for an alternative? If no other alternative available, is slow titration vs regular titration preferred?
What would be your next treatment for a young adult patient with medulloblastoma refractory to repeat resection, craniospinal irradiation, and initial...
If so, for how long?
Would the checkpoint inhibitor still work if blocking only that portion of the inflammatory cascade as opposed to more global blockade with steroids?
Is there any data supporting this?
In patients with suspected CIDP, does the use of imaging—MRI (thickening or abnormal enhancement of cervical/lumbar nerve roots or brachial/lumb...
Are VDRL titers useful?
Do you just use antibiotic prophylaxis if therapy is started prior to meningococcal vaccination?
Based on this review (Melamed and Lee, PMID 31998289), patients with MS on several DMTs may be at higher risk for certain cancers. How does this play ...
Is there data for CGRP inhibitors?
How do you treat medically refractory sleep related movement disorder in patients who has failed medical management with dopamine agonists, gabapentin...
Do you order any imaging beforehand? Are there other studies that you order?
If patients are asymptomatic, what work up do you typically proceed with?
What is your preferred approach to a pregnant patient who is in status migrainosus that is refractory to first line treatments?
Do EMG studies such as myoclonus or tremor studies change your management?
Is there a clinical scenario in which using the 10mg/100mg Carbidopa/Levodopa formulation is preferred to or more beneficial than using the more commo...
When do you consider a blood patch?
Especially forms of non-pharmacologic treatment, such as physical therapy or special devices.
While it is an excellent score for objectively assessing concerning EEG features, there are pathologies where it can be argued that long-term monitori...
When should we consider getting DaT scan in patient suspecting of Parkinsonism syndrome?
We often use abdominal binders and compression stockings, in addition to hydration and midodrine/fludricortisone. However, are there more targeted the...
Do we prophylactically place patients on anticoagulation after one episode?
Besides MRI/MRV brain, are there other diagnostic imaging that should b...
With studies showing rare risk of developing epilepsy after PRES do you just taper medications over the following weeks-months? Any need for outpatien...
(e.g. Alzheimer's disease)?
If not, then what is your preferred treatment and would you integrate SRS into it?
Do you have a particular cutoff?
Although probably more familiar to ophthalmologists, orbital apex syndrome refers to the consequence of any kind of swelling or mass effect within the...
Do you ever recommend any specific sequences on MRA?
For example, a GAD65 Ab of 0.07 when the cut-off is 0.02. Does this answer change if you consider adult vs pediatric populations?
Instead of waiting for the antibody test to result, if you have a high suspicion for NMDAR encephalitis, is there a role for giving rituximab alongsid...
Is there a role for using a trial of pyridostigmine as a diagnostic aid in a patient with suspected (but not confirmed) myasthenia gravis?
For patients clinically presenting with Transient Global Amnesia and no other focal neurologic deficits, do you always pursue work up to rule out stro...
Do you prophylactically start all patients on B12, B-complex, and/or omega-3? If so, what dose? What about ice mittens and booties?
Do you ever add prophylactic Keppra (levetiracetam) for glioblastoma patients without a seizure history based on data such as this study (nature.com) ...
Which triptans are safer in stroke induced migraines?
Does your management change in any way?
What is the cost and accessibility of CYP2C19 gene testing? Does the limited availability of rapid genotyping techniques limit the clinical applicabil...
In patients presenting with likely statin-induced myopathy versus statin-induced autoimmune necrotizing myopathy - how do you approach the decision re...
How often are you scanning the brain and what is your trigger to treat?
How do you counsel young adults with antibody-negative necrotizing myopathy on prognosis, risk of recurrence, and long-term monitoring/treatment?
How do you plan to incorporate the results of the CHANCE-2 trial (Wang et al., PMID 34708996) in your own practice?
What is the etiology/pathology for tinnitus in Intracranial hypotension? How often is this symptom encountered in patients with intracranial hypotensi...
No thrombus detected on echocardiogram and no evidence of atrial fibrillation is present.
Do you perform routine screening for coronary artery disease in aging patients already taking these therapies?
For patients who present with elevated myoglobin in the setting of normal creatinine kinase and exercise intolerance, what work up process do you typi...
If so, what would you consider ordering?
What are your thoughts on the ethics of inpatient use of sedatives in these patients to help with agitation to “protect themselves from harm and...
Is there role for IVIG? Would you alter the dose or time course of steroid therapy?
Which holistic treatments for migraine without aura do you recommend for patients who are refractory to standard treatments?
Occasionally, patients referred for dedicated epilepsy management for "medication refractory epilepsy" are found to have purely non-epileptic spells. ...
What referrals do you recommend/imaging orders?
In the setting of no personal or family history and no other risk factors for thrombosis, is systemic anticoagulation warranted if local treatments (e...
Since these patients or their caregivers may not know the symptoms related to sleep disorders and the negative effects on their already compromised ne...
This question is intended to include consideration of cardiac diagnostic screening, as well as initiation & maintenance of lamotrigine, in epileps...
What effective modalities have you found for acute exacerbations of trigeminal neuralgia including in patients who present to the ED?
How can one safely taper off and stop clonazepam in a woman of reproductive age with epilepsy who is taking it chronically for epilepsy and is plannin...
If so, what percent likelihood do you quote patients for this risk with SRS, SRT and fully fractionated therapy?
Do you routinely discontinue the device or continue if they are otherwise tolerating the treatment well?
What is the diagnostic yield and complication rate in your experience?
How do you approach secondary stroke prevention for patients with ischemic stroke, atrial fibrillation, and signs of cerebral amyloid angiopathy/micro...
What factors influence your thinking?
Do you wait for a second clinical event or start immunomodulatory therapy right away?
How do you manage botulinum toxin injections in a patient with cervical dystonia after getting implanted with DBS?
Do you require neurosurgical evaluation first? Do you require any patients to wear a neck brace?
How do you treat dangerous behavioral disturbances (aggression, nighttime wandering) in patients with dementia with Lewy bodies (DLB)?
If you have significant side effects, GI and/or cardiac with one of the cholinesterase inhibitors, would you try using another medication or would you...
The most frequently taught cause of asterixis is hepatopathy and of course hepatic encephalopathy, and has other close associations (ie, uremia), I ha...
How do you manage freezing of gait in Parkinson disease when dopaminergic therapy worsens the freezing phenomenon?
I teach my students/residents that they should hardly ever get routine X-rays in patients presenting with radicular symptoms. MRI far better for seein...
Specifically, what do you do if there is minimal improvement with IV steroids and/or IVIG?
NCCN lists PCV as category 1 (and now with analysis in Abstract 2002 from ASCO 2019 showing benefit in IDH mutated), and temozolomide as 2B, yet temoz...
For what duration do you use therapy?
Is there any benefit to starting hyperosmolar therapy prior to the development of depressed level of consciousness or midline shift?
Are there contraindications to drugs like oxaliplatin or abraxane?
Does chronicity or severity of the patient's underlying symptoms play a role in yo...
Do you just see if the tremors are more associated with action versus static tremors? What are other clinical characteristics that can be helpful to c...
The thought being, if no clearly defined lesion exists on available neuroimaging, how do we balance the benefits, risks, and uncertainty in choosing w...
In patients diagnosed with pseudotumor cerebri, is vaginal delivery safe? How do you manage this condition during the pregnancy?
Are there any specific patient populations that you are no longer routinely recommending to start B-cell depleting medications? For example, are you l...
e.g. DITP from eptifibatide after a cardiac intervention
What would be the next steps in these cases?
Based on the results of the recent longitudinal analysis linking EBV infection and MS (Bjornevik et al., PMID 35025605), can negative EBV antibodies (...
For medical oncologists, would you offer a PD-1/L1 inhibitor? For other subspecialties, how would you counsel the oncologist regarding the risk of usi...
For example, a clinically stable patient on eculizumab, do you continue it indefinitely?
By completely unremarkable, I mean zero clinical events AND zero interictal abnormalities despite full withdrawal of medications. Assume, for the sake...
What testing do you typically proceed with?
Do you typically recommend MRI or CT?
How do you treat refractory focal status epilepticus in an adult with history of alcoholism and traumatic bilateral subdural hematomas who is failing ...
Additionally, what is the current role for temporal artery ultrasound in workup for GCA?
What is the your preferred loading (and maintenance) dose for use of Perampanel in the treatment of refractory status epilepticus?
What would be your preferred technique and dose/fractionation?
Specifically, how do you treat the delayed headache, not the headache that develops during the infusion where pre-hydration and slowing down the rate ...
How does presence of intraventricular hemorrhage change your recommendations?
The question is broad and is meant to include patients who have healthy BMD, osteopenia, and osteoporosis, as well as exposure to first generation AED...
For stroke-like migraine attacks after radiation therapy (SMART syndrome), does your management of these patient's change with recurrent episodes? How...
Can intrathecal methotrexate be continued with close neurologic observation vs switch in treatment now due to findings?
If so, when do you consider this?
Is there a role for immunomodulatory therapy?
Do you biopsy immediately, stop treatment, biopsy at a later time, or depend solely on the data you already have?
What modality do you prefer?
How do you approach treatment?
At what point do you consider genetic testing?
Are there any reasons you avoid therapy?
When would you consider treatment with steroids in patients with diabetic radiculoplexus neuropathy?
Are there any alternative treatments?
Is there any additional benefit to radiation in addition to steroids in a patient who is not a surgical candidate?
Given the bleak prognosis in HD, how do you decide which patients will benefit from DBS to treat the chorea?
In what clinical scenario would you refer a patient for embolization? Are there any contraindications?
Can you expand on this by sharing exactly what this routine workup should include? What additional tests outside of evaluating for POEMS and amyloidos...
How long do you wait (from onset of symptoms) to do a EMG/NCS in a patient with GBS?
Myositis specific antibodies and pathology results often take weeks to result. In which cases do you start therapy before the diagnosis is solid...
What other workup/clinical examination findings do you look for?
Is there is a particular pattern of extraocular motility restriction in Miller Fisher syndrome?
Ex. optical coherence tomography, visual-evoked potentials
What is the best way to determine if patients with new PCA territory infarct can drive? Upon discharge from the hospital, do you routinely refer them ...
Thoughts on sarilumab vs methotrexate, or just treat with steroids alone
How would you treat patients with symptoms of AIS who have an allergic reaction to TPA with no evidence of large vessel occlusion on imaging? What nex...
Small study in pediatric PACNS have evaluated this as a potential marker (Cellucci et al., PMID 22740622)
For a relatively young, medically compliant patient with HFrEF (EF<35%) and h/o embolic stroke, what is the consensus of starting AC for secondary ...
How do you manage ADHD in patients with Tourette syndrome in order to prevent exacerbating the tics such as with medications like Aderall?
Is there an AED of choice?
Presuming that work-up for cardioembolic sources is negative, how would you proceed?
Does this add any value?
Has the recently published interim analysis of the CATNON trial altered your utilization of temozolomide?Does IDH status change your treatment approac...
Do you consider the small, but statistically significant, improvement in OS to outweigh the side effects of treatment?
Length of temozolomide course when given with adjuvant radiotherapy
If not, how often do you repeat pelvic imaging?
In patients undergoing continuous EEG monitoring in the ICU, we often encounter EEG patterns that lie along the inter-ictal continuum (IIC). In such c...
What are common side effects to look out for with Eteplirsen?
Ie through electrodiagnostic, imaging, and otherwise?
Are there contra-indications while breast-feeding?
At what point could starting AEDs be considered for patients with recurrent simple febrile seizures?
What steps should be taken to wean them off?
For example, with a Watchman device? What is the evidence behind this?
Do you approach things differently if a rare variant like this is suspected? Is the Balo's subtype more similar to RRMS or PPMS?
What factors play into your decision whether to re-treat the brain with craniospinal radiotherapy vs irradiation of the spine only vs other measures (...
Specifically, do you reach for Rituximab or cyclophosphamide?
Patients can develop sensory and motor symptoms such as paresthesias, jaw/facial pain and stiffness, cramping and twitching, ptosis and vision changes...
If so, how do you decide when to restart anticoagulants?
When would you consider stenting or CEA even if there is less than 50 obstruction when no other etiology has been found?
E.g. The case in question is for a patient planned for thoracic RT for LS-SCLC. Any medications that may help or just give much bigger expansions to c...
When do you favor RT? What is your preferred dose/fractionation?
How does length of time from prior chemoradiotherapy influence your management?
Given the slow recovery of nerve damage, what would you expect to see on a repeat EMG after treatment? Continued denervation or just sequelae of past ...
In a palliative setting, how long would you wait to initiate WBRT?
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