Discover and read the best of Twitter Threads about #NeuroTwitter

Most recents (24)

In my job as a pediatric neurologist, we consult with pregnant people if a brain abnormality was found on ultrasounds. We provide information on prognosis. If the prognosis is bad or high risk, elective pregnancy termination should be an option. (1/9)
We also prescribe anti seizure meds to people with epilepsy, who need to take these meds for months, often years. Some of these meds have potential to cause serious birth defects, or have unknown safety during pregnancy. (2/9)
Same goes for migraine meds, immunologic meds (treatment for multiple sclerosis, etc). Even if neurologists and insurance companies require a contract or proof of contraception, birth control isn’t 100% effective. (3/9)
Read 9 tweets
Bilateral locomotor brachialis in a middle aged patient with severe hypertension and severe dizziness under eval ? post circulation stroke --> 280/170 mmg Hg (manually measured 4 times by 4 different people)

HTN is a killer!

Patient consent taken before recording and posting video on SM!
Read 5 tweets
1/ Time for another illustrative learning case in the form of a 🧵#tweetorial #medtwitter #neurotwitter #neurocriticalcare #neurology. Case deidentified as always
2/ Young human with no medical history but IVDA (heroin, cocaine, PCP) with multiple prior overdoses and recent discharge from drug rehab 2 days prior who presents to #ED after acting funny
3/They were noted to be lethargic, GCS 13, not able to provide history. CT demonstrates cerebellar edema with #hydrocephalus (💧) and some ⬆️ transtentorial 🧠 herniation
Read 21 tweets
12 Principles for rounding and case presentations for medical students,

residents, and attendings who are forever residents at heart

Whether you are presenting to the attending or calling in a consult,

it is your responsibility to convince
Where is this going?

Are you lost?

I am!
Read 21 tweets
1) Have you ever seen a case of rabies?

I saw two cases 5 years back and they have stayed with me since.

I do not fear any disease per se but I am not ashamed to say that I dread rabies --> it is a terrible affliction.
2) The first patient was a small child of around 7 years old --> he had been bitten by a street dog around 1 month back. But his family had opted for natural healers.

When he was brought in, he was crying uncontrollably with a terror stricken expression on his face.
3) Hydrophobia, as commonly believed, is not so common in these cases. Why you ask?

Its because these patients are so extremely agitated and combative, its very difficult to get close to them, let alone make them drink water.
Read 16 tweets
1) Bell's palsy (BP) is typically defined as an IDIOPATHIC unilateral LMN type CN7 palsy.

It is named after the Scottish neurophysiologist, Charles Bell. (vide infra)
2) But an LMN type CN 7 palsy is NOT the same as Bell's palsy.

It is merely the idiopathic form, often thought to be due to herpes or varicella induced direct nerve damage or as post infectious demyelination.
3) There are certain RED FLAGS in the diagnosis of an LMN type CN 7 palsy.

1. Vesicles on the tympanic membrane or ear canal (Ramsay Hunt syndrome type 2)

2. Bilateral involvement - Lyme disease, sarcoid, GBS, Melkersson-Rosenthal syndrome, Mobius syndrome etc!
Read 12 tweets
One of my favorite #histmed stories is the discovery of EEG by Hans Berger in the 1920s. #NeuroTwitter

At age 19, Berger (1873-1940) fell off a horse. On the same day, his sister, miles away, sent a telegraph to ask if he was doing ok. 1/10
He was fine, but he thought he had communicated his frightened thoughts about getting hurt to his sister by telepathy. He decided to study psychiatry, to learn more about inter-brain communication. 2/10
Berger wanted to measure the "psychic energy" that, he thought, tied us all together. He wrote about the "radioactivity of the brain," he studied circulation, he measured temperature of the brain during mental exertion (in a 23 yo patient with a gunshot wound to the head) 3/10
Read 10 tweets
📌How to design a brain 101🧠🏗️

A 🧵 on how I use @powerpoint to create illustrations

🎨Key tools and my 2 secret weapons:

-@gboulouis adding "advanced" stuff
-@MVarkanitsa reviewing every little detail

#MedTwitter #MedEd #NeuroTwitter #NeuroRad #Neurology #neuropath #FOAMed
This 🧵 is inspired by a great recent post from @teachplaygrub, since we are using similar methods and tools on #PowerPoint!

🛠️ The Basic Toolkit:
-curve function ➰
-edit points function✴️
-Layering 🃏
-Zooming (x300-400%) for details 🔍

🎨 colors, shadows, 3D effects etc., depends on individual's style

Read 15 tweets
🚨Early management of Intracerebral Hemorrhage🩸🧠

📒 My cheat-sheet
(focus on approaches to limit hematoma expansion)

#MedTwitter #neurotwitter #NeuroTwitter #NeuroRad #Neurology #Neurosurgery #stroke #MedStudentTwitter @gboulouis @marco_pasi85 @NMatch2023 #FOAMncc
⚡️For anticoagulation reversal in ICH, see this high yield and simple algorithm from @American_Heart updated ICH 2022 guidelines🩸🧠 @StrokeAHA_ASA
For a quick summary of the @American_Heart updated ICH 2022 guidelines 🩸🧠, the recent 🧵 that @MicieliA_MD put together is amazing

Read 5 tweets
💥Dramatic Intracerebral Hemorrhage🩸🧠 expansion.

Hyperacutely➡️again showing that the window for intervention in ICH is pretty narrow!


🙏🏿@VancouverStroke for reminding me of these cases!

#neurotwitter #NeuroTwitter #NeuroRad #Neurology #Neurosurgery #stroke
Here is the case of ongoing bleeding @VancouverStroke mentioned yesterday. @TheLancet @TheLancetNeuro…
Read 4 tweets
The🟡 Spot Sign might be dead🧟🧟‍♂️ for ICH🧠🩸!

(At least as practice-changing marker for Intracerebral Hemorrhage expansion)

🍄ICH shape/density markers on plain NCCT are more promising👇🏿👇🏿

#neurotwitter #FOAMrad #radres #NeuroTwitter #NeuroRad #Neurology #Neurosurgery #stroke Image
NCCT markers of hematoma expansion picture from:

These markers still need harmonization and improvement of diagnostic accuracy.. Image
Read 6 tweets

#Newpub #Hotofthepress : A concrete application of our recent paper stressing the importance of assessing reliability of trial outcomes: validation of the simplified mRS for treated brain aneurysm pts!

#Tweetorial #RadRes #NeuroTwitter #RadTwitter
What previous paper, you say? In case you missed it, please check out why evaluating reliability for RCT outcome measures is as important as for diagnostic tests, if not more:
As everyone knows, mRS is widely used for evaluating functional outcome in stroke pts.

A simplified version (smRS) was proposed by Bruno et al. for easier adjudication.

While reliability was extensively studied for stroke pts, it wasn't for patients with treated aneurysms.
Read 11 tweets
The spectrum of Marfan syndrome and related connective tissue disorders is intriguing and mind-bending 💫✨

Here is a🧵exploring it

@CPSolvers @rabihmgeha @DxRxEdu @Sharminzi @AnnKumfer @rav7ks @sargsyanz @DrCindyCooper @jackpenner @MatthewHoMD @ASanchez_PS

#2 Skeletal manifestations

-Tall stature
-Long slender arms & legs
-Pectus excavatum
- Pectus carinatum
-Joint hypermobility
-Pes planus
-Camptodactyly (bent fingers)
-Micrognathia & Retrognathia
-Malar hypoplasia

#3 Cardiovascular

-Mitral valve prolapse (can lead to CHF & arrhythmias)
-Aortic aneurysms
-Aortic root dilation
-Aortic dissection
-Aortic regurgitation
-Pulmonary artery dilation (often asymptomatic)

#MedTwitter #CardioTwitter @Gurleen_Kaur96 @KannuBansalMD @this_is_svenka
Read 19 tweets
🚨Acute #stroke case (from the archive):

Patient in 60s presents with sudden onset fluctuating LOC, dysarthria, mild right arm weakness (disabling)

Last seen normal 2hrs (witnessed onset).

You urgently take to CT- motion artifact, no clear early ischemic changes. CTA normal. Image
2 schools of thought/approaches:

Approach #1⃣: Acute onset, disabling symptoms- proceed with lytic 💉and defer CTP

Approach #2⃣: Dx is still a bit unclear (ddx: seizure⚡️, etc)- proceed to CTP

If in camp #2, here are the CTP maps (CBF, MTT, Tmax>8s) Image
CTP confirms suspected localization of left thalamus (with possible internal capsule involvement).

CTP helped confirm the etiology (not a mimic), but delayed lytic administration by about 7-10 min (did not change management).

Which camp/approach are you in for this case🧠?
Read 4 tweets
The only good thing to come of finding this on my leg last week: I learned enough to write a #tweetorial about it

A 🧵/twitter PSA about what to do if a tick comes for you – & what neuro presentations you can see w/ tick-borne illnesses

#MedTwitter #NeuroTwitter #IDTwitter
After time outside in a non-wooded area, I found this on my leg. I didn’t realize what it was, so I grabbed it & flung it off... only to then find a very active, crawling tick on my counter. 😱

So after freaking out for a moment (or 2), I had to figure out what to do with it.
Memories from med school flashed into my head of what you’re SUPPOSED to do:

1⃣ Remove tick w/ tweezers
2⃣ Grab close to skin & pull tick off without twisting so it doesn’t break apart
3⃣ Disinfect

Since I had already accidentally messed up 1⃣ & 2⃣, I started w/ 3⃣
Read 17 tweets
Everyone loves those pretty colored fMRI pictures with the blobs. But what do they mean? How do they make them?
A #tweetorial called “F— that: Understanding fMRI”. #FOAMed #medtwitter #Medstudenttwitter #neurotwitter #FOAMrad #neuroradiology #radiology
fMRI is based on a principle called “neurovascular coupling.” This is the principle if there is increased neuronal activity in a region, there will be increased blood flow to that region to meet the increased demand
Think of it like a baby crying because it is hungry—parents immediately rush to feed it. The increased oxygen demand of the neurons immediately brings increased fuel to feed it.
Read 17 tweets
“You don’t get points for having your needle in the right place if you don’t get a diagnosis.” When we biopsy the skullbase we work to get a diagnosis.
A sort of #tweetorial but more like a 🧵about our skullbase biopsy system. #FOAMed #medtwitter #neurosurgery #neurotwitter Image
Unless the lesion is difficult to diagnosis w/FNA (ie, schwannoma), we begin by FNA w/an 18g draw needle & a 22g Quincke needle. We do not aspirate, b/c the skullbase is very vascular, & too much blood will be drawn up, making it difficult to tell if the sample is diagnostic. Image
However, if we are not getting a diagnosis with FNA, we will move to a core. If it is a deep lesion, we will use the Biopince system, beginning with a 17g, 7 cm introducer. This is an example of IgG4 disease of the trigeminal nerve that failed FNA and required a core Image
Read 7 tweets
re: ICH Prevention in People w ⬆️Risk MRI findings in @American_Heart updated 2022 ICH guidelines🧠🩸

📌 Refers to incidentally found MRI markers of small vessel disease (SVD) - a common question

Prompted by @interneurona unpacking below (short 🪀)
For context:
🚫MRI is not routinely done for risk stratification of first-ever spontaneous ICH risk

🔮MRI is occasionally available in certain people/pts w/o ICH: may show SVD markers concerning for future ICH risk

〽️These markers are: microbleeds, superficial siderosis

The populations that this might be relevant to are:
- healthy elderly
- ischemic stroke
- memory clinic
- any pt who got a brain MRI for a different indication (e.g. migraines)
- non-ICH cerebral amyloid angiopathy (CAA)

#neuroradiology #Alzheimers #stroke

Read 12 tweets
Why is cranial nerve 6 uniquely affected by⬆️ intracranial pressure? Why is it special? A common question after the CN6 tweetorial.
Here is a maybe #tweetorial, but maybe a🧵about why CN6 is alone affected by ⬆️ pressure. #FOAMed #medtwitter #Medstudenttwitter #neurotwitter Image
Think of the intracranial CSF space like a balloon, distended by CSF instead of air. Cranial nerves begin inside the balloon, and then they exit as they begin their extradural portion Image
Most cranial nerves move immediately away from the CSF space after they exit—usually going out through their respective foramina. However, CN6 uniquely runs along the outside of the “balloon” in Dorello canal Image
Read 7 tweets
🦪 IDK about you but I did NOT learn about "vision tilting" as part of lateral medullary syndrome. I had a stroke code this AM where patient woke up to find the room appeared to be flipped "like a mirror image, upside down". #MedTwitter #neurotwitter
Involvement of the vestibular nuclei in lateral medullary lesions can result in nystagmus and diplopia (which we are taught), but can also result in vertical image displacement, referred to as 'environmental tilt'!!
This is due to injury to do the otolithic projections that typically help our vision to mediate "counter rolling"
Read 6 tweets
A conversation I have every week in @yaleneurons resident clinic: let's talk triptans. A basic approach for all you #neurotwitter and #medtwitter folks who aren't board certified in headache medicine 🤯but see these patients- just like me!
This topic is dear to my heart b/c I have migraines and let me tell you- migraines. are. awful. My life was changed when I got triptans. Gimme some suma + high dose NSAIDs = 😃 But not all triptans are created equal! If your patient fails one, it doesn't mean you're out of luck.
Let's say you start with sumatriptan 50mg PO (my usual starting choice) and the patient has side effects. What should you do?
Read 9 tweets
Pathway to Green Card via J-1 Waiver Job

#medtwittter #neurotwitter #IMG

These are the steps in chronological order 👇🏼
Disclaimer: I am not an immigration lawyer. The information below is based on my experience and personal research. Do your own research
1. Visa for employment in a J1-waiver job : H1b

Sponsored by employer

3-year commitment to working in a “healthcare underserved area”

Pro tip: the physician contract should state that the employer will sponsor a green card and start the process during the 3-year employment
Read 18 tweets
Hi #MedTwitter #MedStudentTwitter #neurotwitter #MedEd #FOAMed! It's been too long since my last #EndNeurophobia #tweetorial so here's an introduction to brain imaging–thanks @sarrovasta for the request!🧠❤️
cc:@CPSolvers @rabihmgeha @DxRxEdu @AvrahamCooperMD @caseyalbin
Let's start w/CT. I'll focus on brain (and not bone or soft tissue). First:

* Identify normal structures and any abnormalities in:
- Size
- Shape
- Symmetry
(note *symmetric* abnormalities such as ventriculomegaly or diffuse cerebral edema may not be obvious w/o experience)


* Identify abnormalities
- Hypodensity
- Hyperdensity


• Hypodensity:
- Ischemia
- Inflammation
- Infection
- Neoplasm

• Hyperdensity:
- Blood
- Calcification
- Hyperdense tumors (e.g. lymphoma)
- Thrombus in vessel
- Contrast enhancement

Read 19 tweets
#NeudrawlogyMigraineEdition, part 5! 🤕 🧠

Here goes a review of the preventive treatments for migraine! 🧵 (1/10)

✅ Learn here:
🎯 Indications;
💊 General recommendations about the treatment.

#NeuroTwitterNetwork #NeuroTwitter #FOAMed #MedEd #MedTweetorial
1/❓But first, a question:
A 28-year-old woman with migraine without aura has 2 attacks/month lasting 8h, and her episodes are relieved by NSAIDs. Would you prescribe her a preventive migraine treatment?
2/❓Let’s suppose the same person has hemiplegic migraine with 1 attack/year. Would you treat her?
Read 18 tweets

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