Discover and read the best of Twitter Threads about #STROKE

Most recents (24)

Less common symptoms of stroke

1. Weakness of one side of face, arm or leg; and speech impairment are the commonest symptoms of stroke.
However, it is important to be aware of lesser known symptoms of stroke, so that an early diagnosis can be made.
#MedTwitter #stroke…
2. Sudden onset Confusion- due to involvement of speech area (located in left side of brain) concerned with comprehension of spoken words. Patients are unable to appropriately respond to queries and keep talking something that doesn't make sense. (Sensory or Wernicke's aphasia).
3. Drooping of one eyelid and weakness of opposite side of body- occurs due to involvement of midbrain.
4. Dizziness, slurred speech, imbalance while walking- occurs due to involvement of brainstem+/- cerebellum (posterior circulation stroke)
Read 8 tweets
10 commonly asked questions about stroke answered

1. Stroke affects heart
#stroke affects brain and causes paralysis.
#heart attack is known by the term myocardial infarction.
#MedTwitter #NeuroTwitter…
2. Common symptoms of stroke:
*Weakness of arm, leg or face, usually on one side
*Inability to understand spoken words or to speak
*Imbalance while walking
*Reduced vision on one half or in one eye
*Sudden onset severe headache
3. Risk factors for stroke
*High blood pressure
*High total and LDL cholesterol or high triglycerides and low HDL
*High homocysteine
*Heart diseases
*Alcohol consumption
*Lack of sleep
Overweight or obesity
*Older age
*Family history of stroke
Read 10 tweets
Patients with Inflammatory bowel diseases (IBD) have a higher risk of suffering a stroke

1. Persons with Crohn's disease or ulcerative colitis have an increased risk of developing thrombo-embolic events. A recently published study looked at the association between IBD & stroke.…
2. >85,000 patients with IBD were followed up long-term (1969-2019), and the risk of stroke in them was compared to those without IBD.
Patients with IBD had 14% higher risk of suffering from ischemic stroke during follow up.
#MedTwitter #stroke #IBD
3. The elevated risk of stroke remained increased even 25 years after diagnosis, corresponding to one additional stroke case per 93 IBD patients until then.
Read 5 tweets
An important teaching case

A 45 year old lady with significant vascular risk factors presented with hyperacute onset dimness in the L side of her field of vision, specially in the bottom half.

There is no other significant neurological or systemic hx.
Clinical examination revealed only a BP - 150/90, R arm, sitting position with confrontation perimetry showing an incongruent, incomplete L sided homonymous hemianopia.
A homonymous hemianopia localizes posterior to the optic chiasma where the nasal hemiretinal fibers decussate.

A L sided HH localizes a lesion to the R post-chiasmatic visual pathway.

Incongruency argues for a relatively anterior localization of the lesion ie away from cortex. Image
Read 10 tweets
🚨ARE THE JAMIE FOXX RUMORS TRUE⁉️ #VaccineInjured #Blind #Stroke
**Thread 🧵**
📌Rumors have been swirling about Jamie Foxx's health condition, with some speculations that he had a stroke or is now blind. #JamieFoxx
📌Nick Cannon, a close friend of Foxx and fellow entertainer, has stepped in during Foxx's recovery. Cannon has been respectful of Foxx's privacy, stating that he only shares information given to him and asked of him. #NickCannon #RespectPrivacy Image
📌Cannon had previously offered to be a mouthpiece for Foxx and his camp but was turned down politely. Foxx's team seems to prefer to handle the situation on their own terms. #SupportingFriends
Read 8 tweets
Effective treatment of #depression through psychological therapy is associated with lower risk of #stroke and #heartattack
1. 6,36,955 people with depression were treated with psychotherapy and were followed up for a median of 3.1 years.
#MedTwitter Image
2. Reliable improvement from depression was associated with a 12% decrease in incident risk of cardiovascular disease (CVD) at any given time, with similar results observed for coronary heart disease (CHD), stroke, and all-cause mortality (death).
3. Benefit was maximum in those aged 45-60 years. For this group, the improvement in depression was associated with a 15% decrease in cardiovascular diseases. In patients over 60 years of age, there was only a 6% decrease.
Read 7 tweets
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 #ESOC #medstudent #neurorad #radres #meded #radtwitter #stroke #neurology #neurotwitter Image
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 diagnosis a stroke. Image
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 loss of gray white differentiation & sulcal effacement Image
Read 13 tweets
1/ 76 yo woman suffers an ischemic stroke in the left media territory, initial NIHSS 5. Treated with IVT. NIHSS at 24hs 3 points, new diagnosis of #AFib on the #Stroke unit monitor/ECG… 24h MRI shown belowê When would you start anticoagulation?
2/ When would you start DOAC therapy in this woman?
Let's dive into the NEWEST evidence to find the optimal timing! #StrokeCare #AFib @ELAN_Trial @FishingNeurons #ESOC2023
3/ Non-valvular atrial fibrillation accounts for about 25% of ischemic strokes. Early recurrent strokes are common, but starting oral anticoagulation too soon may increase the risk of harmful intracranial bleeding. We need a balance… or do we??? Image
Read 26 tweets
Wood burning can cause cancer, esp lung cancer, respiratory disease, heart disease, dementia, premature death, & other health issues which are devastating. Wood burning emits more CO2 than gas. Inaction and silence on this affects everyone.
No laws to stop residential burning (fireplaces, fire pits, backyard burning, planned burns), & no public campaign on the dangers of residential burning means anyone can burn and emit smoke into your home. No action now, leaves you, the next generation, & environment unprotected
Read 6 tweets
All about #Stroke !
( Thread alert )💥

Amongst the ten deadly diseases in the world, STROKE ranks the second largest killer disease following coronary artery disease.
The estimated prevalence rate of stroke in India is 84-262/100,000 in rural areas and 334-424/100,000 in…… Image
Types of stroke:
There are two main types of stroke:
Ischaemic stroke (blood clot) and haemorrhagic stroke (bleed).

Ischaemic stroke is caused by
✤High blood pressure
✤High cholesterol levels
✤Excessive alcohol intake
✤Irregular heart…… Image
Know the Symptoms -BEFAST

Stroke can be easily identified by the symptoms like
✤Facial droop
✤slurred speech
✤ weakness or numbness in limbs/paralysis
✤blurred vision/sudden loss of vision
✤ dizziness
✤ increased confusion
✤difficulty in swallowing and
✤loss of…… Image
Read 7 tweets
Stroke is the third leading cause of death and disability (the first two are heart attack and cancer). Treatment of #stroke is time-bound, and less than 10% of people receive the clot-buster drug therapy. Therefore, most people who survive a stroke are left with disabilities.
12 preventive strategies can be easily followed, and they have the potential to significantly reduce one's chances of suffering from stroke.
These are:
1. Sleep for 7-9 hours at nights;
2. 150 min of moderate-vigorous exercise per week;8000-10000 steps/day;
3. Healthy food;
4. Maintain ideal body weight;
5. Minimize the daily sitting duration to less than 6 hours;
6. Quit smoking;
7. Abstain from alcohol;
8. Reduce stress;
9. Maintain BP less than 120/80 mmHg;
10. Target HbA1C less than 5.7% (the lower, the better);
Read 4 tweets
Lack of sleep as well as excess sleep are associated with increased risk of stroke

1. A recent research looked at the association between sleep disorders (in the previous month) and risk of stroke in 4496 people.…
#MedTwitter #neurotwitter #sleep #stroke
2. Short sleep (<5 hours), long sleep (>9 hours), impaired sleep quality, difficulty getting to sleep or maintaining sleep, unplanned napping, prolonged napping (>1 hour), snoring & breathing cessation (OSA) were all significantly associated with increased odds of acute stroke.
3. Short sleep (<5 h) was associated with a 3.1 times higher risk of stroke, and long sleep (>9 h) was associated with 2.7 times higher risk of stroke, as compared to those who slept 7 hours.
More the number of sleep disturbances, greater was the risk of stroke.
Read 5 tweets
Common cause of nerve damage is often overlooked due to lack of awareness

1. 41-year old Mr Sheel presented with tingling, burning sensation & numbness of both feet of one year duration. Symptoms were present throughout the day, however, they worsened during nights.
2. Mr Sheel consulted a general physician, who ordered a few blood tests, which were all "normal". He suspected a diagnosis of peripheral neuropathy (damage of nerves in feet) and referred him for a neurologist's opinion for confirmation of diagnosis.
3. Neurologist evaluated Mr Sheel and found evidence of sensory neuropathy involving lower limbs (confirmed by nerve conduction studies). He also ordered a few additional blood tests, which were all "normal". He advised nerve biopsy test to find out the cause of nerve damage.
Read 7 tweets
💥#McMaster #CardiologyGrandRounds by @johneikelboom
🩸 People with #AF are inadequately anticoagulated, largely related to MD hesitancy
🩸#Bleeding risk prediction tools have modest performance
🩸Bleeding risk iproportional to stroke risk, net benefit favours #antocoagulation
🩸Few reasons to withhold #OAC, even in frail, older adults
🩸Across spectrum of #bleeding risk in AF, #stroke risk is higher
🩸#DOACs preferred over warfarin in #nonvalvular #AF
🩸Most #DOACs safe in #CKD, some require dose adjustment
🩸Dabigatran contraindicated in eGFR<30
🩸Limited RCT evidence in #Hemodialysis

#AtrialFibrillation #Anticoagulation
Read 4 tweets
1/Time is brain! But what time is it?

If you don’t know the time of stroke onset, are you able to deduce it from imaging?

Here’s a #tweetorial to help you date a #stroke on MR!
#medtwitter #meded #neurotwitter #neurology #neurorad #radres #radtwitter #radiology #FOAMed #FOAMrad
2/In up to 25% of acute stroke patients, the time of last known well is well, not known. Then it’s important to use the stroke’s MR imaging features to help date its timing. Is it hyperacute? Acute? Subacute? Or are the “stroke” symptoms from a seizure from their chronic infarct?
3/Strokes evolve, or grow old, the same way people evolve or grow old. The appearance of stroke on imaging mirrors the life stages of a person—you just have to change days for a stroke into years for a person. So 15 day old stroke has features of a 15 year old person, etc.
Read 22 tweets
Lowering triglyceride with medicines does not result in better clinical outcome

1. High serum triglyceride levels are associated with increased incidence of heart attack, stroke and death. In a recent research, the effect of pemafibrate (which lowers triglycerides) was tested.
2. 10,497 patients with type 2 diabetes, mild-to-moderate hypertriglyceridemia (triglyceride level, 200 to 499 mg/dL), and high-density lipoprotein (HDL) cholesterol levels, 40 mg/dL or lower received pemafibrate (0.2-mg tablets twice daily) or matching placebo.
3. The median baseline fasting triglyceride level was 271 mg per deciliter, HDL cholesterol level 33 mg per deciliter, and LDL cholesterol level 78 mg per deciliter. All patents were on statins.
The median follow-up of patients was 3.4 years.
#CardioTwitter #stroke #HeartAttack
Read 6 tweets
Depression is associated with higher risk of stroke

1. In a study on 26,877 people (40% women; mean age 62 yrs), people with pre-stroke depressive symptoms during previous 12 months had 46% higher risk of acute stroke.
#MedTwitter #neurotwitter #depression #stroke
2. The risk of hemorrhagic stroke increased by 56% and ischemic stroke by 44%, if people had depressive symptoms in 12 months prior to stroke.
A larger magnitude of association with stroke was seen in patients with a greater burden of depressive symptoms.
3. People with depression also had poorer functional outcome one month after stroke (the risk of physical disability one month post-stroke was higher in people with depressive symptoms).
Read 4 tweets
Repeated short-duration numbness of one side of body: prompt management can prevent a disabling disease

1. 51-year old Mr K presented with three episodes of numbness of left side of face, arm and leg in the past 20 days. Each episode lasted only 10 minutes.
2. Mr K also had feelings of tingling sensation in the affected areas. He had no weakness and could move his left arm & leg normally during those episodes. His speech also remained normal.
After 10 min, he used to have complete recovery from numbness and tingling.
3. Mr K was a healthy person, with normal weight and BMI. He had no known medical illness. However, he consulted me for expert opinion.
The history was very typical of a neurological problem. Clinical examination was normal. I asked for appropriate investigations.
Read 9 tweets
I'm turning 45 this week.

I just learned I have cognitive impairment akin to early stage Dementia or Alzheimers usually seen in someone 30 - 40 years older than i am.

I'm loosing it y'all.

Had a cognitive/memory assessment done today w one of my neuro.

They are trying to access the extent of the damage from the strokes & subsequent brain damage & progression.

My memory loss is getting much worse. I forget everything.

I have damage in frontal lobe, basal ganglia, progressive #encephalomalacia in right parietal lobe, volume loss, lesions throughout brain & brain stem, 4 inoperable 🧠 #aneurysms, mass around pineal gland & #chiari.

My brain's ravaged from #strokes & Covid.
Read 11 tweets
1/Does the work up for dizziness make your head spin?

Wondering what you should look for on an MRI for dizziness?

Here’s a #tweetorial on what you can (and can’t) see on MRI in #dizziness

#medtwitter #meded #neurotwitter #neurorad #radres #HNrad #neurotwitter #stroke #FOAMed Image
2/The etiology for dizziness depends both on how you define dizziness (i.e., vertigo, imbalance) & where you see the patient

For imaging, subtle distinctions in symptoms usually aren’t provided & many common diagnoses are without imaging findings (BPPV, vestibular migraine) Image
3/The most important finding on imaging for dizziness is a stroke from vertebrobasilar insufficiency (VBI)

It's a relatively uncommon etiology of dizziness, but its prevalence increases in emergent/acute dizziness populations

Missed VBI can have profound consequences/morbidity. Image
Read 24 tweets
The blood-brain barrier (BBB) is a crucial defense mechanism for the brain, regulating the exchange of molecules between the bloodstream and the brain. When the BBB is disrupted, it can have severe consequences for brain health. (1/12)
Alzheimer's disease is one example of a condition that is exacerbated by BBB disruption. When the BBB is compromised, amyloid beta-peptide deposits can accumulate, leading to #inflammation and disruption of neuronal function. (2/12)
A disrupted BBB in #Alzheimers means astrocyte and microglia inflammation, disruption of synaptic transmission, and myelin destruction. (3/12)
Read 12 tweets
🚨Portland EMS 911: -scanner
10:25AM -12:33PM (Under 2 hrs)
Chest pain / Cardiac
Possible death
Chest pain / Cardiac
Chest pain / Cardiac
Cardiac arrest
🚨Portland 911: -scanner
8:00PM - 8:59PM
Cardiac arrest
Fainting/ Collapsed
Chest pain
Chest pain
Cardiac arrest
Cardiac problem
The new normal #Cardiacarrest #heartattack #EMS #911
Portland 911: 3 reported #Siezures in under 30 minutes. The new normal. #cardiacarrest #heartattack #stroke #seizure #diedsuddenly
Read 7 tweets
1/Do you know all the aspects of, well, ASPECTS?

Many know the anterior circulation #stroke scoring system—but posterior circulation (pc) ASPECTS is often unknown

Here’s a #tweetorial to help you remember pc-ASPECTS
#medtwitter #neurotwitter #meded #neurorad #neurology #FOAMed Image
2/Many know anterior circulation ASPECTS. It uses a 10 point scoring system to semi-quantitate the amount of the MCA territory infarcted on non-contrast head CT.

If you need a review: here’s my tweetorial on ASPECTS: Image
3/But it’s only useful for the anterior circulation. Posterior circulation accounts for ~25% of infarcts. Even w/recanalization, many of these pts do poorly bc of the extent of already infarcted tissue. So there’s a need to quantitate the amount of infarcted tissue in these pts Image
Read 12 tweets
1/I always tell my fellows, “Anyone can see the bright spot on diffusion—what sets you apart is if you can tell them why it’s there!”

Can you tell a stroke’s etiology from its appearance on MRI?

Here’s a #tweetorial to show you how!

#medtwitter #neurotwitter #stroke #neurorad
2/First a review of the vascular territories.

I think the vascular territories look a butterfly—w/the ACA as the head/body, PCA as the butt/tail, and MCA territories spreading out like a butterfly wings.
3/Of course, it’s more complicated than that.

Medially, there are also small vessel territories—the lenticulostriates & anterior choroidal.

I think they look like little legs, coming out from between the ACA body & PCA tail.
Read 25 tweets

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