Discover and read the best of Twitter Threads about #Neurosurgery

Most recents (24)

1/Time is brain! So you don’t have time to struggle w/that "stroke alert" head CT
Here’s a #tweetorial to help you with the CT findings in acute stroke #medtwitter #FOAMed #FOAMrad #medstudenttwitter #medstudent #neurorad #radres @medtweetorials #stroke #neurology #Neurosurgery
2/CT in acute stroke has 2 main purposes—(1) exclude intracranial hemorrhage (a contraindication to thrombolysis) & (2) exclude other pathologies mimicking acute stroke. However, that doesn’t mean you can’t see other findings that can help you diagnose a stroke.
3/Infarct appearance depends on timing. In first 12 hrs, the most common imaging finding is…a normal head CT. However, in some, you see a hyperdense artery or basal ganglia obscuration. Later in the acute period, you see the insular ribbon & sulcal effacement
Read 13 tweets
1/Remembering spinal fracture classifications is back breaking work!

A #tweetorial to review the scoring system for thoracic & lumbar fractures—“TLICS” to the cool kids! #medstudenttwitter #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
2/We’ll talk about the imaging part of TLICS. TLICS scores a fx on (1) morphology & (2) posterior ligamentous complex (PLC) injury. Let’s start w/morphology. W/only mild axial loading, you get the simplest fx, a compression fx—like a simple long bone fx--worth 1 pt.
3/As the axial force grows, this becomes a burst fx with retropulsion of the posterior vertebral body—just as greater force causes more comminution in long bone fxs. A burst is worth 2 points.
Read 10 tweets
1/Is remembering cerebellar anatomy making you dizzy? Need help telling your flocculus from your nodule?
Here’s some help w/a #anatomy #tweetorial on the 9 lobules of the vermis!#medtwitter #FOAMed #FOAMrad #medstudent #neurorad #radres @medtweetorials #neurosurgery @StefanTigges
2/Coming from anterior, the first lobule is the lingula. It sticks out from the front of the vermis & is connected to the superior cerebellar peduncle. I remember this bc it has a very appropriate name—lingula—it looks like a tongue sticking out of the vermis to lick the SCP.
3/Moving clockwise, next is the central lobule. I remember this bc it is positioned exactly how a central lobule should be positioned, in the driver’s seat—where the front seat driver position would be if the vermis was a car—up front, looking out the windshield over the lingula
Read 12 tweets
1) A terrible crash at the Grand Prix today, but thankfully no lives were lost --> and it is all thanks to this man.
2) Who was he?

Dr Eric Sidney Watkins |(1928-2012) , commonly known in Formula 1 (F1) as Professor or Prof Watkins was an English neurosurgeon.

He was the FIA F1 Safety and Medical delegate, head of the F1 medical on track team and first responder for a period nearly 26 years.
3) He is most famous for treating Ayrton Senna, the Brazilian three-time F1 champion who died in 1994 in a crash at the San Marino Grand Prix in Italy. He was only 34 at that time.

Here is a pic of the two together!
Read 9 tweets
1/Do radiologists sound like they are speaking a different language when they talk about MRI? T1 shortening what?T2 prolongation who?
Here’s a translation w/a #tweetorial introduction to MRI
#medtwitter #FOAMed #FOAMrad #medstudent #neurorad #radres @MedTweetorials #neurosurgery Image
2/When it comes to bread and butter neuroimaging—MRI is definitely the butter. Butter makes everything taste better and packs a lot of calories. MRI can add so much information to a case Image
3/In fact, if CT is a looking glass into the brain—MRI is a microscope. It can tell us so much more about the brain and pathology that affects the brain. So let’s talk about the basic sequences that make up an MRI and what they can show us. Image
Read 22 tweets
Dear #hr in #niin #ksom #usc, I know you are busy,but could you spend 8 mins on my emails pls? I sent 6 emails from April to June, and called you every day this week, but I didn’t get any reply. #neuroscience EAD will be expired at 07/10😩@USC @KeckMedUSC @KECKSchool_USC @USCNIIN ImageImageImageImage
Thanks,friends in #twitter in #niin,#ksom, #usc, in #neuroscience, #neuroimaging, #neuroradiology. I really appreciate your support. I got the email this afternoon. It’s my fault. Even leave, leave with pride, grace, and gratitude, no regret. The 4 yrs will be the best memory in Image
my life, although it is also the hardest 4 yrs. Hope other colleagues could take my lessons, and prepare everything earlier in the future.
Read 31 tweets
1/Understanding cervical radiculopathy is a pain in the neck! But knowing the distributions can help your search
A 🧵to help you remember cervical radicular pain distributions #medstudenttwitter #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
2/First, a rule of thumb—or rather a rule of elbow! You have 10 fingers. If you divide that in half, you get 5. Similarly, if you divide your arm in half at the elbow, you get 5--C5 that is! C5 radiates towards the elbow. So if it radiates below this, it is > C5 & above is < C5
3/So let’s start with C2. C2 predominantly radiates along the dorsal aspect of the scalp, as it supplies the greater occipital nerve. I remember this bc the number 2 has a swan like neck that mimics the contour of the back of the head and its distribution
Read 9 tweets
1/Radiologist not answering the phone?Just want a quick read on that stat head CT?

Here's a little help on how to do it yourself w/a #tweetorial on how to read a head CT!
#medtwitter #FOAMed #FOAMrad #medstudenttwitter #medstudent #neurorad #radres @MedTweetorials #neurosurgery Image
2/In bread & butter neuroimaging—CT is the bread—maybe a little bland, not super exciting—but necessary & you can get a lot of nutrition out of it. MRI is like the butter—everyone loves it, it makes everything better, & it packs a lot of calories. Today, we start w/the bread! Image
3/The most important thing to look for on a head CT is blood. Blood is Bright on a head CT—both start w/B. Blood is bright bc for all it’s Nobel prizes, all CT is is a density measurement—and blood is denser (thicker) than water and denser things are brighter on CT Image
Read 20 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
1/As my attending once said, “If I’ve seen it once, I’ve seen it…well once.”
A 🧵about an interesting case that I’ve seen once in 15 years and never again. #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #Neurosurgery #HNrad Image
2/Pt with history only of diabetes came in with altered mental status. There were these super bright round balls in their ventricles. It looked like a snowman massacre happened, with big round snowballs in the ventricles Image
3/On MRI, these had intrinsic T1 hyperintensity w/chemical shift artifact--they looked like boba tea pearls floating in the ventricles. Typically, we think of chemical shift w/fat--but these were not fat on the CT!! They did not enhance & otherwise, brain was unremarkable for age Image
Read 4 tweets
Machine Learning Tools for Image-Based Glioma Grading and the Quality of Their Reporting: Challenges and Opportunities #mdpicancers via @Cancers_MDPI @YaleRadiology
@MerkajSara @Ryan_Bahar are an outstanding team that wrote this exciting review on application of #ML to the study of #glioma imaging. After reviewing over 12,000 articles and extracting information from over 80 articles they published their systematic review in @FrontOncology.
But, there was so much more that needed to be discussed, so @MerkajSara & @Ryan_Bahar wrote an expert review of literature with focus on future directions. @YaleMed #Neurosurgery This review is a must read when starting out in #ML & #glioma imaging #Radiomics overview
Read 8 tweets
Pterygopalatine fossa🧵- inspired by ?s from med students in neuroanatomy lab & a resident w/ case of perineural tumor spread on same day! #meded #FOAMrad #medtwitter #medstudents #radiology #neurorad #HNrad #radres #neurology #ENT #temporalbone #neurosurgery #neuroanatomy
The PTERYGOPALATINE FOSSA (PPF) is a space deep in the face/skull base, bordered anteriorly by the maxilla (max sinus), posteriorly by the pterygoid base of the sphenoid, and medially by the perpendicular plate of the palatine bone. 2/22
It’s best to think of the PPF as a crossroads/intersection. Think about the roads that lead to and from it, and the cast of characters that pass through.

Some like to simplify/visualize the PPF as a cube or inverted pyramid.

Read 22 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
Excited to report that @YaleRadiology @Yaleneuroradio1 #BTRG_qMIT has 14 works presented @TheASNR, with 6 of them being oral scientific presentations. @radiology_ninja @AjayMalhotraRad @SamPayabvash #physician_scientists #mentorship 1/15
@YaleRadiology @Yaleneuroradio1 @TheASNR @radiology_ninja @AjayMalhotraRad @SamPayabvash “Systematic literature review on noninvasive predicting O6 Methylguanine-DNA Methyltransferase status in Glioblastoma, using machine learning algorithms on Pre-therapy MR Imaging” Monday 5/16 9:30 am-10:45 am Gibson room @Jan_Lost_ 2/15
“Semi-Automated Longitudinal Lesion Tracking In PACS Reveals High Proportion of Metastatic Lesions Showing Mixed Response To Radiosurgery.” Beekman, Brain Tumors 1: Tuesday 1:07 pm – 1:12 pm @LeonJekel @TheASNR 3/15
Read 16 tweets
CCA - differentiation of reactive lesions from progressive ones following cranial radiotherapy - a thread 1/n

➡️ primary & secondary brain tumors (glioblastoma/brain mets)
➡️ after high dose radiotherapy
➡️ N=33, prospective confirmatory study…
➡️unclear findings on conventional MRI (psPD/RN vs PD)
➡️contrast clearance analysis with 1 h delayed CE MRI, images were substracted from each other
➡️ histopath confirmation
➡️ overall accuracy very high (84%)
➡️ subgroup of secondary tumors with high benefit (accuracy 94%!)
Therefore a potential new standard? Amino acid PET in a smaller subgroup did not outperform CCA @galldiks , perfusion/DWI more prone to institutional deviations/less potential to be standardized? @gminniti2012
Read 4 tweets
1/🧵🎥 This story has a GOOD ENDING!

Look how my patient’s right leg flails around. This is INVOLUNTARY. He’s trying to stop but his brain is doing this against his will. It is “hemiballismus” & was caused by a fungus deep inside his brain. Read🧵
2/ He was having these movements day & night. Unable to sleep. We admitted him to our ICU and realized the fungus Cryptococcus was causing a brain infection called meningitis. He had  no underlying immune diseases or other health problems.

Another 🎥, all shown w his permission
3/ His MRI showed 2 pockets of infection on both sides of his brain in a place called the basal ganglia, which controls movement. This area had to heal for him to rest and be at peace again.

Read 7 tweets
Every speciality who is on (or wants to be) the ‘Mucor’ team- how many are willing to admit a patient with Mucor under their care and manage (even after surgical debridement). How many were admitting before and will admit after the pandemic? (1/n)#Mucormycosis #COVID19India
Some hypothetical consultations in the emergency before and after the pandemic:

#ENT : We will operate and transfer back

#Ophthalmology : Call us during the Surgey, we will coordinate with ENT in the OT, if needed

#Neurology : Continue Amphotericin (2/n)
#Endocrinology : Send us a consultation after admission under primary, we will control sugars

#Neurosurgery :No active neurosurgical intervention required

#Nephrology :We will do renal modification of Amphotericin

#Medicine/ #Infectiousdisease Admit under any of the above
Read 4 tweets
Neuroanatomy TOTD #15🧵
The inner ear #tweetorial--it packs a large functional punch for its small size-strap in!
#meded #FOAMed #FOAMrad #medtwitter #medstudents #radiology #neurorad #HNrad #radres #neurology #ENT #temporalbone #neurosurgery #neuroanatomy #neuroanatomyTOTD
To evaluate the t-bone, best to compartmentalize--external/middle/inner ear (IE). See previous #tweetorial of the ME. The IE is difficult as most structures are obliquely oriented (at different obliquities!)-and can be hard to see on standard views. 2/24
IE communicates with ME via oval&round windows (which allow for transmission&dissipation of sonic vibrations). IE houses sensory organs for hearing/balance/sensing motion. The cochlear&vestibular nerves (CNVIII) transmit signals to the brain via the int auditory canal (IAC). 3/24
Read 25 tweets
Neuroanatomy TOTD #14🧵
Got some requests to do one of the trickiest areas of human anatomy, the #temporalbone. So many named structures! #meded #FOAMed #FOAMrad #medtwitter #medstudents #radiology #neurorad #radres #neurosurgery #neuroanatomy #ENT #otolaryngology

1/21 Image
Whether learning t-bone anatomy as a medical student or evaluating a CT of the t-bone as a radres, it’s best to compartmentalize into external, middle, and inner ear. This thread🧵is on the middle ear: Inner ear to follow, some day:)

2/21 Image
The external ear extends from the external meatus to the TM. The TM should be thin and *almost* imperceptible on CT. Thickened and retracted TM suggests prior pathology (usually otitis media) and scarring.

3/21 Image
Read 22 tweets
Neuroanatomy TOTD #12

The green structure is the amygdala (amygdaloid body) and the yellow structure is the stria terminalis (ST).


#meded #FOAMed #FOAMrad #medtwitter #medstudents #radiology #neurorad #radres #neurology #neurosurgery #neuroanatomy #neuroanatomyTOTD
Time for a deep dive into limbic networks. Bear with me—this is a fun subject. I got carried away preparing slides—it’s hard to know when to stop!

The amygdala is an almond-shaped collection of gray nuclei/subnuclei deep to the uncus and ant to hippocampus in the med temporal lobe. Involved in multiple functions: memory modulation, emotional learning and responses, +important connections w/ the olfactory bulb/cortex.

Read 18 tweets
Neuroanatomy TOTD #11🧵
➡️intracanalicular facial nerve. IAC cross section➡️4 nerves; ant-sup➡️facial, ant-inf➡️cochlear (7-up/coke-down). Post nerves➡️sup&inf vestibular #medtwitter #meded #FOAMed #FOAMrad #neurorad #radiology #radres #neurology #neurosurgery #neuroanatomy
Facial motor nucleus is in the pontine tegmentum; axons loop dorsally around the abducens nucleus, then course anterolaterally, exiting the brainstem at the CPA.
The nervus intermedius (NI) is composed of preganglionic parasympathetic fibers w/cell bodies in the sup salivatory nucleus, taste fibers w/cell bodies in the nucleus solitarius, and somatic sensory input from EAC/external ear, w/cell bodies in the spinal nucleus of CNV.

Read 11 tweets

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