Discover and read the best of Twitter Threads about #Neuromuscular
Most recents (13)
1/6. This chart shows you everything you need to know about localizing foot drop. But let’s make it even simpler. If dorsiflexion is weak, there is one muscle that really matters: the tibialis posterior, which does ankle INVERSION. Let’s unpack that with a cool mnemonic. 
2/6 Common things are common, and most of the time, a foot drop is caused by either:
- A common peroneal neuropathy at the fibular head or
- An L5 radiculopathy.
- A common peroneal neuropathy at the fibular head or
- An L5 radiculopathy.
3/6. The peroneal nerve (which we already know is responsible for dorsiflexion) has two E’s in it. That should remind you that the PERONEAL nerve is responsible for EVERSION, through supplying the peroneus longus.
#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
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“Myasthenic Crisis”
Keep in mind I’m approaching this with my #NeuroCritCare hat on @MedTweetorials
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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!
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-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.
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On the eve of world FSHD day (June 20), lets look at Facioscapulohumeral dystrophy / THREAD (1/60) #WorldFSHDDay #FSHD #neuromuscular #dystrophy
FSHD is one of the MC muscular dystrophies (third MC after DMD and myotonic dystrophy overall and second MC in adults). Still, it’s a rare disease, but if you are seeing neuromuscular patients, you are likely to see FSHD very often pubmed.ncbi.nlm.nih.gov/25122204/
Name is derived from the pattern of muscle involvement➡️ facial, the muscles around the scapula and those overlying humerus. But it also involves trunk and leg muscles. (3/50)
#NeuromuscularQandA! Questions you always wanted to ask your friendly #neuromuscular doc. RT. #neurology #medtwitter #MedEd #medstudent #neurologyresident Short answers only. Join me in discussing/learning/educating with #passion and #humor @WNGtweets @somedocs @MedTweetorials
Q: Cor blimey doc. You can tell what sort of vitamin deficiency neuropathy the patient has by looking at the blood? #twilight #bella #MedTwitter #MedStudentTwitter #MedEd @AaronLBerkowitz @MadSattinJ @Tracey1milligan @WNGtweets @NinaRiggins @RachelSalasMD @AlexMuccilli
A: Elementary, my dear Watson. #megaloblastic anemia - think B12 and Folate deficiency. #leukopenia - think copper deficiency. Throw in normocytic anemia - think #dysautonomia and small fiber neuropathy. Treat these and we treat #2birdswithonestone. Sherlock, out. @dysclinic
Is it time for #NeuromuscularQandA? Questions you always wanted to ask your friendly #neuromuscular doc. RT. #neurology #medtwitter #MedEd #medstudent #neurologyresident Short answers only. Join me in discussing/learning/educating with #passion and #humor @WNGtweets @somedocs
Q. What’s going on doc. Patient with a shivery tongue. Is it #fasciculations? Is it #ALS? Is it #MG? Is it #tremor? #meded #MedStudentTwitter #MedTwitter @AaronLBerkowitz @Tracey1milligan @RachelSalasMD @DxRxEdu @MadSattinJ @EricLawson90 @NinaRiggins @neurochecklists @WNGtweets
A: Judge the tongue by the company it keeps. If it’s weak and wasted it ain’t tremor. #Musk myasthenia gravis and #ALS tongues may be weak and wasted with fasciculations. So try #steriods - If it responds to steroids it ain’t ALS - gotta be #MG. #clinicaldiagnosis
#NeuromuscularQandA! Questions you always wanted to ask your friendly #neuromuscular doc. #neurology #medtwitter #MedEd #medstudent #neurologyresident Short answers only. Join me in discussing/learning/educating with #passion and #humor @WNGtweets @somedocs @ContinuumAAN
Q: What gives doc? Patient took the prednisone for #myastheniagravis and got worse. Is it a wonky batch?
A: Sometimes you get worse before you get better. 20 percent of #myastheniagravis patients get weaker in 2 weeks after starting steroids. Be careful if they have bulbar or respiratory symptoms - you don’t wanna have a #myastheniccrisis on your hands. @MyastheniaOrg
#NeuromuscularQandA! Questions you always wanted to ask your friendly #neuromuscular doc. #neurology #medtwitter #MedEd #medstudent #neurologyresident Short answers only. Join me in discussing/learning/educating with #passion and #humor @WNGtweets @AANEMorg @CambridgeMedsoc
Q: What gives doc. Got a #myastheniagravis patient. The repetitive stimulations are positive but the AchR antibody ain’t. Ain’t MG an #autoimmune thing?
A: AChR Ab ain’t the only fish in the sea.Try Musk antibody -positive in 40% AChR Ab negative patients. If negative, the waiting game - 20% AChR Ab negative patients seroconvert in a year. Still negative? Ab are teeny tiny and sensitivity of lab testing determines what we see.
A question a day! Questions you always wanted to ask your friendly #neuromuscular doc. #neurology #medtwitter #MedEd #medstudent #neurologyresident Short answers only. Join me in discussing/learning/educating with #passion and #humor @WNGtweets @AANEMorg @AANMember
More on #myastheniagravis we are #onaroll Q: Doc doc. The single fiber EMG is positive for this patient. Ain’t got nothing else. He’s weak so he’s got #myastheniagravis. Right? Right?
A: Congratulations, padawan. The most sensitive #neuromuscular test, you have. #myastheniagravis, it could be. #ALS, it could be. #myositis, it could be. Any disease which affects #muscle, #nerve or #NMJ, it could be. Seek to find what ye are looking for. #Yoda
A question a day! Questions you always wanted to ask your friendly #neuromuscular doc. #neurology #medtwitter #MedEd #medstudent #neurologyresident Short answers only. Join me in discussing/learning/educating with #passion and #humor @WNGtweets @AANEMorg @AANMember
Let’s do more on #myastheniagravis. Q: Doc doc. Patient’s AchR antibodies are super sky high. It’s a crisis! She’s a crisis! We are a crisis!
A: Ain’t no mountain high enough. Them antibody titers don’t correlate with severity or response to treatment - they are good for diagnosis is all. #allornone
In honor of @AaronLBerkowitz let’s do a #neuromuscular Q and A on #footdrop, short answers only. #neurology #neurologyresident #MedTwitter #MedStudentTwitter join me in discussing/learning/educating with #humor and #passion @WNGtweets @AANEMorg @AANMember
Q: What gives doc. Patient’s got a foot drop. What’s the cause of the flop flop flop?
A: Nerve or muscle? #EDB - hypertrophy in myopathy/atrophy in neuropathy. Peroneal nerve or more? #ankleinversion - unaffected if only peroneal. L5 radiculopathy? #hipabduction -affected in L5 radiculopathy. Want more? Checkout @AaronLBerkowitz for more cool #swag
Bonus question! Questions you always wanted to ask your friendly #neuromuscular doc. #neurology #medtwitter #MedEd #neurology #medstudent #neurologyresident Short answers only. Join me in discussing/learning/educating with #passion and #humor @WNGtweets @AANEMorg @AANMember
Q: What up doc. We sent for the AchR antibodies for this #myastheniagravis suspect patient and they came back #positive. Still need the repetitive nerve stimulations to confirm diagnosis?
A: Ye already have the answer ye seek. #RNS less sensitive than AChR antibody testing for #myastheniagravis. #RNS positive in only 50-70 percent generalized MG and 30-50 percent ocular MG. A yes is a yes and 2 yesses ain’t yesser. Less is more #mariekondo
A question a day! Questions you always wanted to ask your friendly #neuromuscular doc. #neurology #medtwitter #MedEd #neurology #medstudent #neurologyresident Short answers only. Join me in discussing/learning/educating with #passion and #humor @WNGtweets @AANEMorg @AANMember
Q: What up doc. My patient has ocular #myastheniagravis for 3 years now. Why hasn’t he got weakness in his arms and legs and breathing and everything?
A: Luck be a lady. 85 percent of ocular MG generalize and most do so within 2 years of onset. So now you know, after 2 years - look in the eyes - that’s where the answers lie.
Launching a question a day! Questions you always wanted to ask your friendly #neuromuscular doc. #medtwitter #MedEd #medstudent #neurologyresident Short answers only. Join me in discussing/learning/educating with #passion and #humor @WNGtweets @AANEMorg @AANMember
Q: What gives doc? Why do you order AchR binding, blocking AND modulating antibodies for #myastheniagravis? Can’t you just choose one?
A: We just like more data. Just kidding. If you have to choose one, take the AchR binding antibodies - they are the most sensitive - positive in 70 percent of generalized #myastheniagravis and 50 percent of ocular. Other 2 Ab are useful if present when the AchR binding Ab ain’t
