Neurology Second Opinions: Improving Accuracy in Stroke, Epilepsy, Parkinsons Disease and Multiple Sclerosis
Neurological disorders often involve complex diagnostic pathways and subtle clinical findings. For conditions such as stroke, epilepsy, parkinsons disease and multiple sclerosis (MS), even small differences in interpretation can change treatment decisions and long-term outcomes. For families and patients in India, a neurology second opinion from a U.S. subspecialist provides clarity, ensures that diagnostic standards are being applied correctly, and opens access to advanced expertise and treatment strategies.
Interview between
Vaibhav Goswami MD
Neurology Second Opinions: Improving Accuracy in Stroke, Epilepsy, Parkinsons Disease and Multiple Sclerosis
Neurological disorders often involve complex diagnostic pathways and subtle clinical findings. For conditions such as stroke, epilepsy, parkinsons disease and multiple sclerosis (MS), even small differences in interpretation can change treatment decisions and long-term outcomes. For families and patients in India, a neurology second opinion from a U.S. subspecialist provides clarity, ensures that diagnostic standards are being applied correctly, and opens access to advanced expertise and treatment strategies.
Interview between
Vaibhav Goswami MD
Neurology Second Opinions: Improving Accuracy in Stroke, Epilepsy, Parkinsons Disease and Multiple Sclerosis
Neurological disorders often involve complex diagnostic pathways and subtle clinical findings. For conditions such as stroke, epilepsy, parkinsons disease and multiple sclerosis (MS), even small differences in interpretation can change treatment decisions and long-term outcomes. For families and patients in India, a neurology second opinion from a U.S. subspecialist provides clarity, ensures that diagnostic standards are being applied correctly, and opens access to advanced expertise and treatment strategies.
Interview between
Vaibhav Goswami MD
Stroke and the Value of Advanced Imaging
What are the different types of acne?Non-inflammatory acne is more mild. It causes whiteheads (closed blocked pores) and blackheads (open blocked pores), but not redness or swelling. Inflammatory acne occurs, as the name implies, when there is some degree of inflammation. It can be further broken down into two categories: mild-to-moderate and moderate-to-severe. What is considered severe acne? Cystic acne is a severe type of inflammatory acne resulting in the formation of often-painful cysts. This type of acne can result in more long-term issues with scarring and post-inflammatory hyperpigmentation. Does it matter what type of acne people have in terms of prognosis or treatment selection? Virtually all cases of acne are treatable. Non-inflammatory acne responds well to over-the-counter treatments and retinoids, which work by preventing the formation of lesions. Retinoids also have some anti-inflammatory properties, so they function well when combined with other medications for inflammatory acne. Mild-to-moderate types of acne also typically respond well to retinoids, as well as to benzoyl peroxide and topical antibiotics. Moderate-to-severe and severe acne cases may require oral antibiotics and other treatments.
Stroke and the Value of Advanced Imaging
What are the different types of acne?Non-inflammatory acne is more mild. It causes whiteheads (closed blocked pores) and blackheads (open blocked pores), but not redness or swelling. Inflammatory acne occurs, as the name implies, when there is some degree of inflammation. It can be further broken down into two categories: mild-to-moderate and moderate-to-severe. What is considered severe acne? Cystic acne is a severe type of inflammatory acne resulting in the formation of often-painful cysts. This type of acne can result in more long-term issues with scarring and post-inflammatory hyperpigmentation. Does it matter what type of acne people have in terms of prognosis or treatment selection? Virtually all cases of acne are treatable. Non-inflammatory acne responds well to over-the-counter treatments and retinoids, which work by preventing the formation of lesions. Retinoids also have some anti-inflammatory properties, so they function well when combined with other medications for inflammatory acne. Mild-to-moderate types of acne also typically respond well to retinoids, as well as to benzoyl peroxide and topical antibiotics. Moderate-to-severe and severe acne cases may require oral antibiotics and other treatments.
Epilepsy and the Role of Specialized Evaluation
What are the different types of acne?Non-inflammatory acne is more mild. It causes whiteheads (closed blocked pores) and blackheads (open blocked pores), but not redness or swelling. Inflammatory acne occurs, as the name implies, when there is some degree of inflammation. It can be further broken down into two categories: mild-to-moderate and moderate-to-severe. What is considered severe acne? Cystic acne is a severe type of inflammatory acne resulting in the formation of often-painful cysts. This type of acne can result in more long-term issues with scarring and post-inflammatory hyperpigmentation. Does it matter what type of acne people have in terms of prognosis or treatment selection? Virtually all cases of acne are treatable. Non-inflammatory acne responds well to over-the-counter treatments and retinoids, which work by preventing the formation of lesions. Retinoids also have some anti-inflammatory properties, so they function well when combined with other medications for inflammatory acne. Mild-to-moderate types of acne also typically respond well to retinoids, as well as to benzoyl peroxide and topical antibiotics. Moderate-to-severe and severe acne cases may require oral antibiotics and other treatments.
Epilepsy and the Role of Specialized Evaluation
What are the different types of acne?Non-inflammatory acne is more mild. It causes whiteheads (closed blocked pores) and blackheads (open blocked pores), but not redness or swelling. Inflammatory acne occurs, as the name implies, when there is some degree of inflammation. It can be further broken down into two categories: mild-to-moderate and moderate-to-severe. What is considered severe acne? Cystic acne is a severe type of inflammatory acne resulting in the formation of often-painful cysts. This type of acne can result in more long-term issues with scarring and post-inflammatory hyperpigmentation. Does it matter what type of acne people have in terms of prognosis or treatment selection? Virtually all cases of acne are treatable. Non-inflammatory acne responds well to over-the-counter treatments and retinoids, which work by preventing the formation of lesions. Retinoids also have some anti-inflammatory properties, so they function well when combined with other medications for inflammatory acne. Mild-to-moderate types of acne also typically respond well to retinoids, as well as to benzoyl peroxide and topical antibiotics. Moderate-to-severe and severe acne cases may require oral antibiotics and other treatments.
Multiple Sclerosis and the Risk of Misdiagnosis
What are the different types of acne?Non-inflammatory acne is more mild. It causes whiteheads (closed blocked pores) and blackheads (open blocked pores), but not redness or swelling. Inflammatory acne occurs, as the name implies, when there is some degree of inflammation. It can be further broken down into two categories: mild-to-moderate and moderate-to-severe. What is considered severe acne? Cystic acne is a severe type of inflammatory acne resulting in the formation of often-painful cysts. This type of acne can result in more long-term issues with scarring and post-inflammatory hyperpigmentation. Does it matter what type of acne people have in terms of prognosis or treatment selection? Virtually all cases of acne are treatable. Non-inflammatory acne responds well to over-the-counter treatments and retinoids, which work by preventing the formation of lesions. Retinoids also have some anti-inflammatory properties, so they function well when combined with other medications for inflammatory acne. Mild-to-moderate types of acne also typically respond well to retinoids, as well as to benzoyl peroxide and topical antibiotics. Moderate-to-severe and severe acne cases may require oral antibiotics and other treatments.
Multiple Sclerosis and the Risk of Misdiagnosis
What are the different types of acne?Non-inflammatory acne is more mild. It causes whiteheads (closed blocked pores) and blackheads (open blocked pores), but not redness or swelling. Inflammatory acne occurs, as the name implies, when there is some degree of inflammation. It can be further broken down into two categories: mild-to-moderate and moderate-to-severe. What is considered severe acne? Cystic acne is a severe type of inflammatory acne resulting in the formation of often-painful cysts. This type of acne can result in more long-term issues with scarring and post-inflammatory hyperpigmentation. Does it matter what type of acne people have in terms of prognosis or treatment selection? Virtually all cases of acne are treatable. Non-inflammatory acne responds well to over-the-counter treatments and retinoids, which work by preventing the formation of lesions. Retinoids also have some anti-inflammatory properties, so they function well when combined with other medications for inflammatory acne. Mild-to-moderate types of acne also typically respond well to retinoids, as well as to benzoyl peroxide and topical antibiotics. Moderate-to-severe and severe acne cases may require oral antibiotics and other treatments.
Parkinson’s Disease: Why a Second Opinion Matters
What are the different types of acne?Non-inflammatory acne is more mild. It causes whiteheads (closed blocked pores) and blackheads (open blocked pores), but not redness or swelling. Inflammatory acne occurs, as the name implies, when there is some degree of inflammation. It can be further broken down into two categories: mild-to-moderate and moderate-to-severe. What is considered severe acne? Cystic acne is a severe type of inflammatory acne resulting in the formation of often-painful cysts. This type of acne can result in more long-term issues with scarring and post-inflammatory hyperpigmentation. Does it matter what type of acne people have in terms of prognosis or treatment selection? Virtually all cases of acne are treatable. Non-inflammatory acne responds well to over-the-counter treatments and retinoids, which work by preventing the formation of lesions. Retinoids also have some anti-inflammatory properties, so they function well when combined with other medications for inflammatory acne. Mild-to-moderate types of acne also typically respond well to retinoids, as well as to benzoyl peroxide and topical antibiotics. Moderate-to-severe and severe acne cases may require oral antibiotics and other treatments.
Parkinson’s Disease: Why a Second Opinion Matters
What are the different types of acne?Non-inflammatory acne is more mild. It causes whiteheads (closed blocked pores) and blackheads (open blocked pores), but not redness or swelling. Inflammatory acne occurs, as the name implies, when there is some degree of inflammation. It can be further broken down into two categories: mild-to-moderate and moderate-to-severe. What is considered severe acne? Cystic acne is a severe type of inflammatory acne resulting in the formation of often-painful cysts. This type of acne can result in more long-term issues with scarring and post-inflammatory hyperpigmentation. Does it matter what type of acne people have in terms of prognosis or treatment selection? Virtually all cases of acne are treatable. Non-inflammatory acne responds well to over-the-counter treatments and retinoids, which work by preventing the formation of lesions. Retinoids also have some anti-inflammatory properties, so they function well when combined with other medications for inflammatory acne. Mild-to-moderate types of acne also typically respond well to retinoids, as well as to benzoyl peroxide and topical antibiotics. Moderate-to-severe and severe acne cases may require oral antibiotics and other treatments.
Stroke and the Value of Advanced Imaging
For patients and families considering or uncertain about a stroke diagnosis or treatment plan, especially when seeking a second opinion, it is important to understand that stroke management and diagnostic workup extend well beyond magnetic resonance imaging (MRI). The initial evaluation typically begins with a non-contrast computed tomography (CT) scan, which is widely available and highly sensitive for detecting intracranial hemorrhage, a critical distinction that guides immediate management. MRI, particularly with diffusion-weighted imaging, is more sensitive for detecting acute ischemic changes, but CT remains the first-line imaging in most emergency settings due to speed and accessibility.
Beyond imaging, a comprehensive workup includes cardiac monitoring (to detect atrial fibrillation), echocardiography (to assess for cardiac sources of emboli), carotid and vertebral artery imaging, and laboratory testing for hypercoagulable states or vasculitis when indicated. The American Heart Association and American Stroke Association recommend a multidisciplinary approach, including rapid neurologic assessment, risk stratification (e.g., using the NIH Stroke Scale), and early secondary prevention strategies.
Epilepsy and the Role of Specialized Evaluation
In epilepsy, second opinions can dramatically change diagnosis and treatment. The National Association of Epilepsy Centers recommends referral to comprehensive centers for patients with uncertain diagnoses, treatment-resistant seizures, or consideration of advanced therapies such as surgery. Specialized evaluations often include long-term EEG monitoring, advanced neuroimaging, and neuropsychological testing, all of which improve diagnostic accuracy. Studies have shown that this expanded workup increases the ability to distinguish true epilepsy from non-epileptic events by 50 percent compared to routine EEG and CT alone. Importantly, while antiseizure medications reduce recurrence risk, decisions about when to initiate treatment and which therapies to pursue require careful review. A neurology second opinion ensures that advanced tools are applied correctly and helps patients avoid both undertreatment and overtreatment.
Multiple Sclerosis and the Risk of Misdiagnosis
Multiple sclerosis presents a particular challenge, as many conditions mimic MS clinically and on imaging. Recent revisions to the McDonald criteria and new international quality standards for MS care highlight the importance of early but accurate diagnosis. Advanced MRI markers, such as the central vein sign and paramagnetic rim lesions, may improve diagnostic precision but require expert interpretation. Misapplication of these criteria has been shown to contribute to significant rates of misdiagnosis. A second opinion from an MS specialist, particularly at a center with access to advanced imaging and disease-modifying therapies, can prevent errors, guide early intervention, and tailor treatment strategies to the individual patient.