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Listening to a lecture on chronobiology today and my mind is blown!

I learned that sunrise is important to our health. Living on the western end of a time zone can mean 20% higher rates of obesity and heart attacks because you see the sun later, but get up just as early. 1/
Our bodies need blue light from the sun to activate the *intrinsically photosensitive retinal ganglion cells* that signal to our suprachiasmatic nucleus (SCN) that it is morning. The SCN then regulates the rest of our circadian processes. #neurotwitter 2/
Now the Ontario government is proposing permanently adopt Daylight Savings Time which would mean setting our time zone to what we currently have in summer (ie. you wouldn’t see the sun until 9am in the winter). The goal is to increase shopping and potentially decrease crime. 3/
Read 10 tweets
1) Migraine Premonitory(Prodromal) Phase::
Presences of non-painful Symptoms, which can start hours to days before the onset of migraine pain and can be predictive of an impending headache.
2) Three Separate Groups of Symptoms::
1::Fatigue & Cognitive changes...
Concentration difficulty, Irritability, depression, fatigue, memory impairment.
2::Homeostatic Changes...
Food craving, Thirst, Yawning, Increased Urination, Sleep disturbance.
3) 3::Sensory Changes...
Photo, phono, osmo, Phobia, nause, neckstiffness.
Read 7 tweets
1) Migraine with AURA::
Recurrent attacks of unilateral fully reversible visual, sensory, or other CNS symptoms that develops gradually over minutes and usually followed by Headache and associated Migraine Symptoms.
2) Total 20-40% prevalent,Increased risk in 1st degree Relative + twins + Heritibility. Onset::
Gradual and progressive, unlike abrupt in Stroke.
AURA consists of Positive symptoms like flashing lights, and paresthesia while stroke dominates Negative symptoms like weakness.
3) Duration::
Typically 30 minutes but may be Prolong upto 4 hours. Symptoms::
Visual(90%,most common) > Sensory, language, motor.
Visual::
Scintillating scotoma, Flashing lights, Blurry Visions.
Read 12 tweets
A #stroke #tweetorial. Inferior division MCA infarct often gets mistaken for PCA territory. Sometimes it can be quite difficult to distinguish MCA vs PCA territory infarcts (especially near the borderzone). #neurotwitter #medtwitter #medstudenttwitter
1/ Reminder of topography: MCA (yellow) and PCA (green) territory. Inferior division MCA (near the borderzone of PCA) involves the occipital lobe
3/ This is an example of a patchy MCA territory infarct. Note that the inferior division MCA affects the partieto-occipital lobe (except for the very medial portion of the occipital lobe, which we already stated is PCA). Red line indicates the borderzone between MCA/PCA
Read 7 tweets
#NeurologyMorningReport #NMR Case 65 #MedTwitter #NeuroTwitter Updates & Answers posted later today. Asking your help #MedEd #neurology #neurologyresident #neurologist #medstudent #NeurologyProud #MedStudentTwitter Join me in educating. Share your questions and knowledge.

1/ Image
Page - 25yo man, hx B cell ALL, ?seizure, now w/ AMS Please come to bedside
Admitted w/diarrhea & GI graft vs host disease
h/o ALL, multiple relapses including leptomeninges now in remission

What further information do you need? What are your 1st thoughts about what's going on?
See image for details of event and vital signs

Medications: tacrolimus, infliximab, remicade

3/ Image
Read 15 tweets
1️⃣ in 🔟 people will have a seizure in their lifetime. Many times they’re told “everyone is allowed one seizure” and meds aren’t started until a second seizure. But why is this?

#neurotwitter #tweetorial
Recurrence risk after a first seizure has been examined in numerous studies. This review by Dr Anne Berg is an outstanding summary.

ncbi.nlm.nih.gov/pubmed/18184149
2️⃣ large-scale randomized trials provide recurrence risk after untreated first unprovoked seizure.

A multicenter study from Italy randomized 193 people to deferred treatment after second seizure. Recurrence risks were 18%,28%,41%,51% at 3,6,12,24 months after first sz
Read 15 tweets
1/4
43yr chronic #alcohol user on Liv.52 #Herbal supplement for 1yr. Believes Liv52='hepatoprotective'. Consumes along with to cancel alcohol-toxicity. Diabetes uncontrolled on #Ayurveda. Comes with #jaundice, severe #headache, eyes 'bulged' 2 days, nasal discharge #livertwitter Image
2/4
At admission, #seizures, uncontrolled, put on #ventilator. Deep jaundice, comatose. Investigations=acute on #chronic liver failure #aclf
#MRI Brain Part 1👇
Extensive hemorrhagic infarcts, almost all of anterior and mid #brain.
#medicine #MedTwitter #radiology Image
3/4
MRI Brain Part 2👇
Both sides cortical venous thrombosis and anterior third of superior saggitsl sinus thrombus.
#imaging #stroke #NeuroTwitter #neurology #NeuroTwitterNetwork Image
Read 5 tweets
Q: Doc, doc, got a 35 year old chap in for terrible muscle aches after running a race. He says his urine is black. What could it be?
A: Black urine suggests myoglobin. What’s his CK? Is it elevated together with other muscle enzymes (AST, ALT, Aldolase)? If so, think rhabdo. Now the question is whether he’s got a provoked attack or has underlying genetic susceptibility.
Read 22 tweets
Strange cause for #cirrhosis
Maybe very #rare #MedEd
53yrs man, voice change, recurrent headaches, male breast enlargement. Stops socialising. Has bleed one day, #endoscopy varices, #biopsy fatty liver cirrhosis
No metabolic syndrome.
MRI Brain done. #livertwitter #radio
1/3 Image
What is the diagnosis?
In patients with cirrhosis, always try to find the cause in those who present early. There is no idiopathic, no cryptogenic. Its all 'missed' cirrhosis.
2/3 #liverpath
#MedTwitter #pathology #radiology #MRI #brain #Neurology #Endocrinology #NeuroTwitter Image
#diagnosis: #fatty liver related cirrhosis due to #pituatory macro adenoma with high prolactin, high GH, low #thyroid function. #clinical examination, acromegaly features with central obesity. #Examine 1st, then investigate. #MedicalStudent #medicine #MedStudentTwitter
3/3
Read 4 tweets
Antibiotics are commonly prescribed medications in the inpatient and outpatient setting and it's important to recognize #AdverseEvents, including idiosyncratic reactions, such as #encephalopathy.

2/
Antibitiotics associated with #Encephalopathy:
- Beta lactams
- #Cephalosporins (#Cefepime is the most common,
Ceftazidime)
- Imipenem
- #Penicillin procaine
- Fluoroquinolones
- Macrolides (clarithromycin)
- TMP-SMX
- #Metronidazole
- Isoniazid

3/
Read 14 tweets
Hi #MedTwitter #NeuroTwitter #medstudenttwitter!
How about another #EndNeurophobia neuroanatomy #tweetorial?

This one goes out to all those USMLE studiers out there:

THE BASAL GANGLIA

cc: @CrystalYeoMDPhD @MadSattinJ @Tracey1milligan @DxRxEdu @CPSolvers @MedTweetorials
Grateful for ❤️ #EndNeurophobia received but hope you read rest of my feed seeking to amplify voices I’m learning from on path to being an antiracist ally.
follow @BlackInNeuro @LashNolen @uche_blackstock @DrOniBee @gradydoctor
listen @thepraxispod @thenocturnists
read @DrIbram
First, the anatomy:

The basal ganglia are islands of gray matter embedded in the subcortical white matter. Texts vary on what they include but most agree on at least:
Caudate
Putamen
Globus pallidus (interna and externa)
Subthalamic nucleus

I’ll call these C, P, GPi, GPe, STN
Read 17 tweets
Cranial nerve testing as emojis. Comment if you have additions/suggestions! #neurotwitter #MedTwitter #WorldEmojiDay #Neurology

CN I
👃
☕️

CN II
🔠🔡 🔠🔡
2️⃣0️⃣/2️⃣0️⃣

👁
🔭🤏

🔦↔️🔦
👁 👁

✌️ ✌️☝️ ☝️
👁 👁
☝️ ✌️☝️ ✌️

📍 📍
CN III/IV/VI
↖️ ⬆️ ↗️

⬅️ 👆👀 ➡️

↙️ ⬇️ ↘️

👍
↕️
👍 ↔️ 👀☝️ ↔️ 👍
↕️
👍

CN V
🧷+👆+🧊
👉 👈
👉 😐 👈
👉 👈

😬

👁👈😭

😦🔨

CN VII
😯
😣
😚
😃

2️⃣/3️⃣:🧂& 🍯➡️👅
CN VIII
🎵👂

CN IX/X
😩🔦

👄👈🤮

🗣

(IX) 1️⃣/3️⃣:🧂& 🍯➡️👅

CN XI
🤷
🌛🌜

CN XII
⬅️👅➡️
⬇️
Read 3 tweets
- Make an initial list of programs you are interested in applying to.
- Do your #research: curriculum, front loaded?, number of residents, night float?, location, categorical or advanced (needs IM prelim)?
- Start asking for LoRs (May have to remind writer at least once)

2/
- Start working on your PS
- Have a note or document on your phone/PC for
ideas: You never know when a moment of inspiration
may happen!💡).
- Make as many corrections as needed
- Contact programs with any questions, specially if something is not clear to you

3/
Read 9 tweets
Functional Gait disorders ("FGD" for the purpose of this #twittorial) are common and disabling, usually accompanied by other symptoms. FGD are challenging for the non #MovDis physician and it can difficult to determine #inconsistencies and #incongruencies during examination.
2/
A good approach is to identify #clinicalSigns to differentiate a #functional vs #organic cause

#Inconsistency is the variability in gait disorder severity over time.
#incongruency involves a combination of symptoms and sins not seen in organic disorders.
#distractibility
3/
Read 19 tweets
#Tweetorial! Continuing with the #NeuroBootCamp my co-chiefs and I are leading @EmoryNeurology on #NeuroEmergencies, today’s #MedEd topic will be:
“Myasthenic Crisis”

Keep in mind I’m approaching this with my #NeuroCritCare hat on @MedTweetorials
1/
Some basic background info: Myasthenia Gravis is an autoimmune disorder causing faulty neuromuscular junction transmission. Typically due to one of the following antibodies:
-AchR
-MuSK
-LRP4
-Can be seronegative

20% have crisis within 1st yr of diagnosis!
2/
Clinically Myasthenia manifests itself with ptosis, fatigable weakness, eye movement abnormalities, and in the case of crisis- respiratory compromise.
3/
Read 20 tweets
1/ Classic #opticneuritis is characterized by a sub-acute loss of vision in one Eye, with central #scotoma, pain on #eyemovement, positive #RAPD
- Fundus exam is usually normal
- Age range 15-45 years
2/Talking about #MOGAntibodies:
- More frequent in #pediatric population, Associated with #ADEM
- #MOG IgG serum titers depend on disease activity and is mainly from extrathecal origin, enters #CNS from systemic circulation and reaches CSF through passive diffusion or broken #BBB
Read 10 tweets
Thanks for all the positive feedback on my clinical neuroanatomy of the arm/hand #tweetorial!
Let's finish off the upper extremity with the brachial plexus!

#Neurology #MedEd #MedStudentTwitter

@CPSolvers @Tracey1milligan @MadSattinJ @MedTweetorials @DxRxEdu

1/
As I wrote, we all probably learned the brachial plexus FIRST in med school, but it's more complicated (and usually less clinically relevant) than knowing the 5 nerves I discussed previously.

So I suggest learn those 5 nerves first, then go back for the plexus!

2/
Do you REALLY need to memorize the entire brachial plexus...?

Yes, if you're a neurologist...or a med student studying for the step (otherwise, this might be just for fun)!

So let's make it easy...

3/
Read 16 tweets
Ok Tweeples, we’re going on a #neurotwitter rapid review of tachy/bradyarrhythmias in strokes. A sprinkle of anatomy/physiology, a mini journal club, and chalk talk all wrapped up into one with a tweet to brain time <4.5min (don’t worry, we’ll spare the EVT 😉) 1/
Starting off. We’ve got our central autonomic network comprising of brainstem structures, as well as subcortical & cortical elements including the A&P insula, Inf & Med-F gyrus, Ant cingulate, vent-med prefrontal cortex, and amygdala. 2/
This is known as the heart-brain axis and is illustrated below: Image
Read 13 tweets
#neurotwitter🎶welcome to the #natverse - we’ve got tools for brains!🎶Open software to analyse neurons, connections, brains #bioRxiv biorxiv.org/content/10.110… Others are using it, why should you? natverse.org: @gsxej lab @MRC_LMB @flyconnectome @CamZoology #rstats 1/10
The natverse allows you to easily plot neurons and neuroanatomical volumes, measure features and implement interesting algorithms, e.g. flow centrality @csdashm and NBLAST @martamcosta2 natverse.org/gallery/. We give lots of examples: github.com/natverse/nat.e… 2/10
Read 11 tweets

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