Discover and read the best of Twitter Threads about #Doubledoc
Most recents (4)
A #practical topic for today. #Pregnancy changes things - but more so for our #neurology patients - or not? #pearls from the #EAN2020 #MedEd #MedTwitter #MedStudentTwitter #neurologyresident @EANeurology @WNGtweets
Let’s first address #multiplesclerosis. Patients get better in third trimester and 30% relapse #postpartum. Immune responses shifts to anti-inflammatory in 3rd trimester to accommodate fetus - #etcomehome - but rebounds after birth. #MedEd #doubledoc #AcademicTwitter
Continue #firstlineinjectables #glatiramer and #interferon - these don’t cause #teratogenicity. In flares, consider IVIG and PLEX. How about #steroids? Usually fine except in 1st trimester when they can cause birth defects #MedEd #MedStudentTwitter #MedTwitter
Now eye enjoyed an important question addressed at #EAN2020. Good to think about when you are called to ED for #opticneuritis. Let’s think about it together. Let’s focus on #clinicaldiagnosismaking #meded #medstudenttwitter #medtwitter #neurologyresident @WNGtweets @EANeurology
How do you tell if it’s optic neuritis or not? #painless #unilateral #altitudinal -means top half or bottom half of the field - vision loss more likely to be non-arteritic AION. Any other red flags less likely to be optic neuritis?
Now if it’s #painful it’s more likely #opticneuritis - but what sort? Bilateral vision loss and painful, think #MOG. Unilateral severe vision loss more than pain, think #Aquaporin4. MRI orbits show longitudinal extensive optic nerve enhancement in both. So MRI orbits for clues.
Shoutout to #EAN2020 @EANeurology for the high yield pearls on #ataxia. Checkout the free #EAN2020 #ataxia workshops for more details but here are a few with my added comments. #MedEd #neurology #MedStudentTwitter #AcademicChatter #doubledoc #neurologyresident @movedisorder
If you think the patient has cerebellar ataxia, think about acquired vs inherited causes. Most common acquired causes are Vitamin (E, B12, B1), Immune (Celiac), Paraneoplastic (Hu, Yo, GAD). Or VIP -cuz it’s Very Important to rule out - as these can be treated. #MedEd #MedTwitter
Then if it’s an older person with autonomic and/or Parkinsonian symptoms - think #MSA-C. But this is #neurodegenerative. #MedTwitter #MedEd #MedStudentTwitter #AcademicTwitter #doubledoc we need research on how to delay progression. @movedisorder
Let’s do a quick one on #clinicaldecisionmaking and #neuroimaging. See bright spot on MRI T2 Brain just means increased water -could be any insult to the brain - #infection #inflammation #ischemia #neoplasm are the top 4 you gotta have in your brain. Pun intended. #MedTwitter
Then you think - active or inactive process? If it’s actively destroying the BBB, it’ll enhance on contrast enhancement. So get MRI with and without contrast. Why without? T2 shine-through - but that’s for another time. #MedStudentTwitter #neurology #neurologyresident
Now the important question here is what you do - remember that nice poem on #theroadnottaken by #robertfrost? 2 widely diverging choices - to immunosuppress or not to immunosuppress. #tobeornottobe #hamlet #MedTwitter #AcademicTwitter #MedStudentChat
