Dr. Andy Southerland and Dr. Dipika Aggarwal discuss her remarkable journey as both a physician and a patient. After overcoming stage four colon cancer, she experienced a life‑altering stroke that reshaped her perspective.

Show transcript:

Dr. Andy Southerland:

Hello everyone. This is Andy Southerland and for this week's Neurology Minute, I've just been speaking with our colleague, Dipika Aggarwal, who's a clinical assistant professor of neurology at University of Kansas, who's been sharing her story for the Physician's Patient series from Cancer Survivorship and as a stroke survivor.

And for the Neurology Minute, we wanted to share an important pearl that Dipika shared with me in her interview about stroke recovery and specifically about mental health outcomes after stroke. So Dipika, please, share with us for the Neurology Minute.

Dr. Dipika Aggarwal:

So yes, my biggest takeaway point from my own stroke experience was the neuropsychiatric complications that can happen as a risk from stroke. The most important ones being post-stroke depression, post-stroke anxiety.

Even if the literature says that they can happen just for 30% of the cases, in reality, I think the incidence is more. But then they can affect quality of life of the stroke survivor, the recovery, and even in some cases can affect their mortality.

So I think it is really important for healthcare providers, especially the neurologists, to ask their patients how they are doing mentally or emotionally. I think it is as important as checking their vitals during every visit. It is as important as that, because again, it can affect their recovery.

Dr. Andy Southerland:

Well, thank you, Dipika. I think it's a good message for all of us in the busyness of our clinics and seeing patients in rapid throughput in and out of the hospital with stroke to make sure that not only in those early days, but also all the way out in the continuum of their recovery, to continue to come back to their mental health recovery.
And their personal recovery, as you've articulated, which is so critical to one stroke recovery. And for this and more, I really encourage our listeners, please listen to the entirety of this interview.

You will come away with it being a better neurologist for your patients. I promise you that. And I'm truly grateful again to Dipika for joining us for this week's Neurology Minute.

Dr. Aaron Zelikovich discusses recent survey findings highlighting the wide variability in how clinicians evaluate and diagnose small fiber neuropathy.

Fill out the Neurology® Clinical Practice Current survey.

Show citation:

Thawani S, Chan M, Ostendorf T, et al. How Well do We Evaluate Small Fiber Neuropathy?: A Survey of American Academy of Neurology Members. J Clin Neuromuscul Dis. 2025;26(4):184-195. Published 2025 Jun 2. doi:10.1097/CND.0000000000000502

Show transcript:

Dr. Aaron Zelikovich:

Welcome to today's Neurology Minute. My name is Aaron Zelikovich, a neuromuscular specialist at Lenox Hill Hospital in New York City. Today, we will discuss a recent article, How Well Do We Evaluate Small Fiber Neuropathy? A survey of The American Academy of Neurology members, which evaluates small fiber neuropathy in clinical practice.

The current landscape of evaluating and testing for small fiber neuropathy remains highly variable in regards to serum testing, skin biopsy, and nerve conduction studies. In this survey study, 800 members of The American Academy of Neurology were randomly selected and emailed a survey. 400 neuromuscular physicians and 400 non-neuromuscular physicians were selected. The overall response rate was 30% with half of the completed surveys coming from neuromuscular physicians. The most common overall initial blood work for this patient population was a CBC, vitamin B12, basic metabolic profile, TSH, and hemoglobin A1C. Other high yield blood tests included ESR, SPEP, immunofixation, and ANA. 70% of responders would also order a nerve conduction study as part of the initial workup. Second line evaluation had less consensus and included skin biopsies for intraepidermal nerve fiber density, hepatitis panel, HIV, and paraneoplastic testing. Responders noted that if the patient had acute onset of symptoms, had symptoms that were asymmetric, or being under 30 years old, they would order a more extensive workup.

The authors discussed the importance of both clinical exam, history, and diagnostic workup in patients with symptoms compatible with small fiber neuropathy. They highlight that there is no current objective gold standard for a diagnosis of small fiber neuropathy. The current diagnostic recommendation by the AAN for distal symmetric polyneuropathy includes serum blood sampling for glucose, vitamin B12, SPEP, and immunofixation. Clinical practice in the diagnosis of small fiber neuropathy remains highly variable based on the provider and clinical context of the patient.

Neurology Practice Current is currently accepting surveys on clinical practice patterns for patients with small fiber neuropathy. Please check out the link in today's Neurology Minute to complete the survey. Thank you and have a wonderful day.

In part three of this four-part series, Casey Kozak discusses the hip abductor sign as an option for assessing weakness in the lower extremities.

Show citation:

Sonoo M. Abductor sign: a reliable new sign to detect unilateral non-organic paresis of the lower limb. J Neurol Neurosurg Psychiatry. 2004;75(1):121-125.

Show transcript:

Casey Kozak:

Hello, this is Casey Kozak with Neurology Minute, and today we're returning to physical exam tests for functional neurological disorder. This episode will piggyback off our last focusing on Hoover's sign, now focusing on other signs of functional weakness. Besides Hoover's sign, another option for assessing lower extremity weakness is the hip abductor sign. Remember that AB-duction means to move away from midline. To perform this test, the patient will be laying on their back. You will then place your hands on the outside of both of their legs. First, you will test the weak leg by asking the patient to push their weak leg outwards in AB-duction against the resistance of your hand. The weak leg will give way easily. Next, you will test the non-affected leg by asking the patient again to push outwards against the resistance of your hand. In a patient with functional weakness, the weak leg may exhibit spontaneous recovery of strength and push outwards against your resting hand while the patient is trying to push their unaffected leg out.

This is an automatic effort by the body to remain midline by engaging the opposite leg, and just like with Hoover's sign, this is based on the principle that the contralateral limb will produce an opposite movement pattern. However, in organic neurological weakness from neurodegeneration, stroke, or peripheral nerve damage, this isn't possible. Therefore, the hip abductor sign is positive if AB-duction of the unaffected leg against resistance causes improvement in the weaker leg's abductor strength. If you're a visual learner like me, don't worry. There's a great diagram for the hip abductor test in a paper by Masahiro Sonoo that we have linked to this episode.

What if a patient has upper extremity weakness? In this case, you can test for drift without pronation. Ask the patient to hold their arms up as of holding a large tray. Then, ask the patient to close their eyes and shake their head no to add distraction to the test and remove visual sensory input. Watch what their arms do. In normal neurological screening examinations, we test for pronator drift, in which the upper motor neuron damage causes a weak arm to fall while the hand pronates or turns inwards. However, in functional arm weakness, you may find that the patient exhibits dramatic drooping of the affected arm without pronation. Keep in mind, however, that this test is not entirely specific, and a musculoskeletal injury to the shoulder, even a remote one, may cause drift alone. If you notice this, it's helpful to inquire about past shoulder injuries. Finally, in any affected body part, you can test for give-way weakness, in which there is a sudden loss of resistance after initial good strength, like a switch was turned off. This abrupt collapse is inconsistent with muscle weakness originating in the musculoskeletal system or a central lesion, and may support a diagnosis with FND.

All right, this gives us plenty to practice with, so let's break again. Join us for the last episode of this series in which we'll discuss functional sensory loss. Until then, happy studying.