Multiple Sclerosis: Is Exercise the Most Powerful Treatment We Have?

Laughing Gas and Spinal Cord Injury

In this episode of Neuro Simplified, we’re talking about nitrous oxide, commonly known as laughing gas, and why recreational use can become a serious neurologic problem. Nitrous oxide can interfere with vitamin B12 metabolism and create a functional B12 deficiency, even when the serum B12 number looks normal or even elevated. That matters because B12 is essential for myelin health. When that pathway is disrupted, patients can develop subacute combined degeneration of the spinal cord, a condition that commonly affects the dorsal columns and can lead to numbness, loss of vibration sense, impaired proprioception, sensory ataxia, weakness, gait instability, and sometimes cognitive changes. One case report described an 18-year-old male with six months of nitrous oxide use who developed progressive limb numbness, unsteady walking, weakness, sensory loss, impaired vibration and position sense, positive Romberg sign, peripheral nerve injury, and acute cognitive impairment. His homocysteine was elevated, and MRI showed cervical spinal cord T2 hyperintensity with posterior column involvement and the classic “inverted V sign.” The big clinical message: do not stop at “B12 is normal.” Nitrous oxide can inactivate B12 at the functional level, so the neurologic exam, homocysteine, methylmalonic acid when available, exposure history, and spinal MRI may tell the real story. Other reports also reinforce that serum B12 may not always reflect true cellular B12 status, and that MRI findings such as dorsal column hyperintensity and the inverted V sign can be key clues. Source: AMA Citations Wu H, Huang H, Xu L, Ji N, Zhou X, Xie K. Case report: Subacute combined degeneration of the spinal cord due to nitrous oxide abuse. Front Neurol. 2023;14:1099077. doi:10.3389/fneur.2023.1099077 Al-Jizani AS, Pathak S, Palit P, Achufusi N. Subacute combined degeneration of the spinal cord caused by an impairment in the functional vitamin B12 metabolic pathway. Cureus. 2024;16(11):e73617. doi:10.7759/cureus.73617 Van Berkel B, Vandevenne J, Vangheluwe R, Van Cauter S. Subacute combined degeneration of the cervical and dorsal spinal cord in a 40-year-old male patient: A case report. Radiol Case Rep. 2021;16(1):13-17. doi:10.1016/j.radcr.2020.10.033 Powered by Google Notebook LM

AFib and Stroke: The Heart-Brain Connection We Can’t Ignore

In this episode of Neuro Simplified, we look at three recent papers on atrial fibrillation and stroke and why this connection matters for prevention, acute care, and rehabilitation. AFib is more than an irregular heartbeat. It is one of the major cardiac contributors to stroke risk, and AFib-related strokes are often associated with worse outcomes. These papers discuss how stroke risk is not always fully explained by traditional scoring systems, why heart structure and comorbidities may matter, and why better detection and long-term management are critical. We also highlight a practical rehab angle: people living with AFib may benefit from more comprehensive care that includes education, physical exercise, symptom management, psychosocial support, and risk factor control. For clinicians, this is a reminder that stroke recovery does not start and stop with the brain. The heart, vascular system, lifestyle factors, and long-term prevention plan all matter. Source: Alonso A, Akin I, Hochadel M, et al. Atrial fibrillation in patients with very high risk for stroke and adverse events: insights from the observational ARENA study. J Clin Med. 2024;13(22):6645. doi:10.3390/jcm13226645. Elsheikh S, Hill A, Irving G, Lip GYH, Abdul-Rahim AH. Atrial fibrillation and stroke: state-of-the-art and future directions. Curr Probl Cardiol. 2024;49:102181. doi:10.1016/j.cpcardiol.2023.102181. Elnegaard CM, Pedersen MK, Zwisler ADO, et al. Atrial fibrillation and primary care prevention and rehabilitation: a feasibility study. Pilot Feasibility Stud. 2025;11:150. doi:10.1186/s40814-025-01724-3. Powered by: Google Notebook LM

Is Dizziness After a Stroke Normal?

In this episode of Neuro Simplified, we look at a 2025 comprehensive review on vestibular rehabilitation after stroke. The review highlights an important gap in stroke rehab: many stroke survivors experience dizziness, gaze instability, balance problems, gait impairments, and vestibulo-ocular reflex deficits, yet vestibular rehab is not always emphasized in standard stroke rehabilitation. The authors explain that eye movement disorders may be present in a large portion of stroke survivors, and vestibular dysfunction can contribute to falls, poor postural control, reduced mobility, and slower recovery. We break down what vestibular rehab can include, such as VOR x1 and VOR x2 exercises, gaze stabilization, habituation, balance training, gait training, head-turn walking, sensory reweighting, and endurance work. The biggest clinical takeaway: vestibular rehab should not be one-size-fits-all. It should be tailored to the patient’s specific symptoms, lesion presentation, visual dependence, balance deficits, and recovery response. This episode is for clinicians who treat stroke and want to think beyond strength, tone, and mobility, because sometimes the missing piece is the system helping patients keep their world still while they move. Source: Fan H, Ding Y, Elmadhoun A, Mangal R, Feng J, Geng X. Vestibular rehabilitation in patients with stroke: a comprehensive review of past and current evidence. Brain Circ. 2025;11(2):107-112. doi:10.4103/bc.bc_16_23.

Why Your Brain Forgets Which Hand is Left and Right After a Stroke

In this episode, we dive into groundbreaking research exploring how stroke impacts the brain’s internal representation of the body, known as the body schema. While traditional rehabilitation for upper limb impairment often produces only modest gains, new evidence suggests that the fundamental way a person perceives their limbs is altered following a stroke. We examine an observational study involving 895 participants that utilized left/right judgment tasks to measure the accuracy and speed of limb recognition. The findings reveal that individuals with stroke are significantly slower and less accurate in identifying the laterality of hand and shoulder images compared to those without stroke. Importantly, these deficits exist regardless of whether the individual experiences chronic pain or which side of the brain was affected. Join us as we discuss how these insights into "scrambled" body maps are shaping the future of motor imagery training and providing a foundation for more effective, tailored neurorehabilitation strategies. Source: Haslam BS, Butler DS, Cocks TS, Kim AS, Carey LM. Body schema as assessed by upper limb left/right judgment tasks is altered in stroke: implications for motor imagery training. J Neurol Phys Ther. 2023;47(1):26-34. doi:10.1097/NPT.0000000000000412. Powered by: Google Notebook LM

Can Dry Needling Support Stroke Recovery?

Dry needling is making its way into stroke rehabilitation, but how safe is it, does it actually ease post-stroke spasticity, and what do the field's leading clinicians actually agree on? In this episode, we break down three studies that together form the most complete picture yet of dry needling's role in stroke recovery. We look at what a 2024 scoping review tells us about safety and adverse events in stroke patients, how an ongoing randomized trial is testing dry needling paired with exercise therapy for spasticity and motor function, and what a 2025 modified Delphi consensus reveals about expert practice recommendations. If you work in neurorehabilitation or just want to understand where the evidence stands, this one's for you. Sources: 1. Malfait I, Gijsbers S, Smeets A, et al. Safety of dry needling in stroke patients: a scoping review. Eur J Phys Rehabil Med. 2024;60(2):225-232. doi:10.23736/S1973-9087.24.08224-8 2. Babazadeh-Zavieh SS, Ansari NN, Ghotbi N, et al. Effects of dry needling and exercise therapy on post-stroke spasticity and motor function– protocol of randomized clinical trial. Contemp Clin Trials Commun. 2022;28:100921. doi:10.1016/j.conctc.2022.100921 3. Velázquez-Saornil J, Abuín-Porras V, Frutos-Llanes R, Barragán-Casas JM, Campón-Chekroun A, Sánchez-Milá Z. Expert consensus on the application of dry needling in stroke patients: A modified delphi method. Clin Rehabil. 2025;39(7):955-966. Powered by: Google Notebook LM