Questions for the Consultant

The “curbside” consultation is a frequent but underappreciated means by which neurologists share clinical expertise. These unofficial sessions are necessarily brief, perhaps lasting the duration of a walk down the hall or elevator journey. They are also focused, patient driven, and occur at or near the point of care. They may enable the generalist or the subspecialist to provide a “value-added” consultation when evaluating a challenging diagnostic or therapeutic problem. In this “Questions for the Consultant” issue of Seminars in Neurology, we present a collection of curbside consultations covering various neurological subspecialties.

In conceptualizing this issue, we asked our colleagues to address questions in their area of expertise that they felt were common, contemporary, controversial, or for which there were seemingly insufficient resources to obtain the answer. We asked them to consider diagnostic, prognostic, counseling, and therapeutic issues. Finally, we requested that they organize their contribution around one or a series of illustrative clinical cases.

We are certain that there will be points of agreement, debate, and perhaps a few epiphanies within this collection. The articles vary in structure and style, much as the practices of the individual clinicians who wrote them. However, we believe they retain the common threads of a systematic approach and reliance on sound clinical judgment that demonstrate the cohesiveness of our subspecialty group practice. Although we endorse “evidence-based” practice and encouraged our contributors to include quantitative information where available, these are largely narrative reviews that attempt to provide the reader with a fundamental approach to common or difficult neurological issues. This will remain the foundation of the “art”of neurological practice even as the diagnostic tools and therapeutic interventions change.

We must acknowledge the contributions of many individuals in making this issue a reality. We thank Dr. Robert Pascuzzi (former Seminars Co-Editor in Chief) and Dr. Karen Roos (current Editor in Chief) for their ardent support for the series format and for the opportunity to contribute to the journal under their stewardship. We are grateful to our enthusiastic cadre of Mayo Clinic consultants whose collegiality and willingness to share their individual expertise, both for this issue and in day-to-day practice, result in an ongoing collaborative effort that is more than simply the sum of its parts. Therefore, we thank Drs. Charles Adler (movement disorders), David Barrs (neuro-otology), Peter Bosch (peripheral neuropathy), Jonathan Carter (multiple sclerosis), Richard Caselli (dementia), John Caviness (movement disorders), Bart Demaerschalk (cerebrovascular disease), David Dodick (headache), Joseph Drazkowski (EEG), Eric Eross (headache), Jerry Evidente (movement disorders), Jonathan Gladstone (headache), Lois Krahn (sleep disorders), Smriti Nagale (peripheral neuropathy), and Benn Smith (EMG). We continue to learn from them and hope that the reader does as well.