Discover and read the best of Twitter Threads about #neurologist
Most recents (17)
Ignoring transient vision loss in right eye could have been risky for a 50-year old
1. 50-year old Mr Raj presented with symptoms of sudden onset loss of vision in right eye, which recovered in 30 minutes. It first occurred 30 days back and recurred a week back.
#MedTwitter
1. 50-year old Mr Raj presented with symptoms of sudden onset loss of vision in right eye, which recovered in 30 minutes. It first occurred 30 days back and recurred a week back.
#MedTwitter
2. As his #vision had completely recovered a month back, Raj ignored it and did not seek medical help. When it recurred for the second time, he decided to see an #ophthalmologist.
Eye check up was normal and he was referred to a #neurologist.
#neurotwitter
Eye check up was normal and he was referred to a #neurologist.
#neurotwitter
3. On enquiry, he had complete loss of vision in right eye on both the occasions, which lasted for 30 and 20 minutes respectively. He had no headache or any other neurological symptoms.
He was taking medicines for high BP for two years.
The diagnosis was clear by now.
He was taking medicines for high BP for two years.
The diagnosis was clear by now.
Case of a woman whose shoe size increased from 5 to 7 over two years
1. It was an usual OPD, when I was counselling one of my patients with back pain about exercise, diet and correct posture. Incidentally, I noticed his wife's face who was sitting beside the patient.
#MedTwitter
1. It was an usual OPD, when I was counselling one of my patients with back pain about exercise, diet and correct posture. Incidentally, I noticed his wife's face who was sitting beside the patient.
#MedTwitter
2. Her nose & lips appeared a bit larger than usual. When she smiled, her teeth were little spaced out and tongue was also little larger than normal. She spoke with a little heavy voice.
Being a #neurologist, I was imagining the possibility of a brain #disease.
#neurotwitter
Being a #neurologist, I was imagining the possibility of a brain #disease.
#neurotwitter
3. I asked her- "Don't mistake me, but has your shoe size increased?" Her eyes almost popped out. She replied with a shocked expression- "doc, yes! It has increased from 5 to 7 in the past two years. Don't everyone's feet become larger as they grow older?"
She was 37-year-old now
She was 37-year-old now
How a common nutritional deficiency turned an air hostess into a beggar
1. A few years ago, a smartly-dressed man entered my OPD with a shabbily-dressed woman, introducing her as his wife. Her hair was unkempt, clothes untidy and she wore a pair of torn sandals.
#MedTwitter
1. A few years ago, a smartly-dressed man entered my OPD with a shabbily-dressed woman, introducing her as his wife. Her hair was unkempt, clothes untidy and she wore a pair of torn sandals.
#MedTwitter
2. The gentleman further added: "She was an airhostess in a German airlines, whom I met while flying as I frequently flew to Germany for business. She was 25-yr old, pretty and it was love at first sight, culminating in #marriage. Things started to change within a few months."
3. She developed progressive #memory impairment, mostly for recent events. She had problems in calculation, speaking, and used to get lost in familiar places. One day, she left home to visit a well-known friend's place, but never reached there. She didn't return home either.
How I (a #neurologist) helped a student pass in #Mathematics, which his Mathematics teacher couldn't manage
1. A 15-year old boy was brought to my clinic by his parents asking for some "pill" that would improve his interest and skill in mathematics, enabling him to pass exams
1. A 15-year old boy was brought to my clinic by his parents asking for some "pill" that would improve his interest and skill in mathematics, enabling him to pass exams
2. He was a bright class 10th kid doing well in all the subjects except in mathematics. His scores were 85-90% in other subjects, with <30% in mathematics. This appeared odd to me. On enquiry, the boy told "my mind switches off when solving complex mathematical problems".
3. The boy continued "my mind keeps on lapsing into absent-mindedness several times during exams" and "before I realize- the time is up". As per his teachers & parents, his answer sheet had many areas of ineligible scribbling. The initial part of answer would be correct though.
Exactly 7 years ago, I spent #StrokeAwarenessDay undergoing emergency #thrombectomy for #basilar artery occlusion. #BAO
Today, I'm still in awe and celebrating how #modern #medicine saved me from locked-in syndrome and enabled me to live a normal life, against all odds.
1/ 🧵
Today, I'm still in awe and celebrating how #modern #medicine saved me from locked-in syndrome and enabled me to live a normal life, against all odds.
1/ 🧵
2/ So far, I have avoided sharing this information as part of my professional life, fearing it would somehow disqualify me as a credible clinician-scientist. Finally, I realize that the experience only strengthened my resolve to give future patients the second chance I was given.
3/ What happened in brief:
I was a healthy, 25yo medical student, all excited to have finished the first 10K run of my life not even 5 hours before my family reacted #FAST and called 911.
I was a healthy, 25yo medical student, all excited to have finished the first 10K run of my life not even 5 hours before my family reacted #FAST and called 911.
1) Welcome to a new #accredited #tweetorial on parenteral #antiplatelet therapy in #neurovascular interventions. Our expert author is Fawaz Al-Mufti MD @almuftifawaz, interventional #neurologist Interventional Neurologist @NYMedcollege @WestchesterMed @neurocritical @svinsociety
2) This program is intended for #healthcare providers & is accredited for 0.5h CE/#CME for #physicians #PhysicianAssociate #nursepractitioner #nurse #pharmacists and is supported by educational grants from AstraZeneca, Bayer, and Chiesi.
3) Be sure to see prior tweetorials on #antiplatelet management, still available for credit, at cardiometabolic-ce.com/category/plate…. Faculty disclosures are listed at cardiometabolic-ce.com/disclosures/.
1) #longcovidkids Group post.
16 mths of fighting to get a diagnosis.
“Finally had in writing confirmation today from my kids #neurologist to my #GP that they both have #PIMS / #MISC, along with #postcovid immune mediated neuropsychological syndrome/#PANS and #longcovid,
16 mths of fighting to get a diagnosis.
“Finally had in writing confirmation today from my kids #neurologist to my #GP that they both have #PIMS / #MISC, along with #postcovid immune mediated neuropsychological syndrome/#PANS and #longcovid,
2) Took 16 months of fighting for them to get heard!! How many of our children have some form of PIMS/MISC that has gone unacknowledged and untreated for so long!
I think there’s so many unrecognised by medics to greater or lesser degrees but it’s all the same
I think there’s so many unrecognised by medics to greater or lesser degrees but it’s all the same
3) - Inflammation & immune mediated response!
My children had a 40 + temp for 3 wks solid and dangerously low oxygen levels (85%) and struggled to breathe every day, blue lighted to hosp yet medics couldn’t wait to get us out and gave us virtually no help. I
My children had a 40 + temp for 3 wks solid and dangerously low oxygen levels (85%) and struggled to breathe every day, blue lighted to hosp yet medics couldn’t wait to get us out and gave us virtually no help. I
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🧵
Link: bit.ly/3ixnWcx
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🧵
Link: bit.ly/3ixnWcx
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
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.
#medtwitter
#medtwitter
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What is the most worthless electrolyte on the BMP, and why is it chloride?
Agree?
A #tweetorial 🧵 to change your mind…
And if you’re thinking, why in the world is this a #neurotweetorial? Read on. #neurotwitter @MedTweetorials
What is the most worthless electrolyte on the BMP, and why is it chloride?
Agree?
A #tweetorial 🧵 to change your mind…
And if you’re thinking, why in the world is this a #neurotweetorial? Read on. #neurotwitter @MedTweetorials
2/
First, this #tweetorial is based on a lecture given in @emoryneurocrit didactics by one of our *awesome* teachers: Dr. Ofer Sadan (@neuro_intensive), and is shared in #tweetorial format w/ his permission.
First, this #tweetorial is based on a lecture given in @emoryneurocrit didactics by one of our *awesome* teachers: Dr. Ofer Sadan (@neuro_intensive), and is shared in #tweetorial format w/ his permission.
3/
So, again, why is a #neurologist interested in chloride?
Because neurologists ❤️ giving chloride.
Ur thinking, “No. I have literally never ordered chloride.” … But, think of all the 23.4% and 3% sodium you have ordered.
All that sodium comes with a bystander: Chloride.
So, again, why is a #neurologist interested in chloride?
Because neurologists ❤️ giving chloride.
Ur thinking, “No. I have literally never ordered chloride.” … But, think of all the 23.4% and 3% sodium you have ordered.
All that sodium comes with a bystander: Chloride.
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.
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.
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.
Photo, phono, osmo, Phobia, nause, neckstiffness.
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.
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.
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.
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.
1) Absence Seizures::
Age 5 years to 10 years, history of febrile seizures in only significant.
Simple TAS:
Sudden onset of impaired Consciousness with blank facial stare without other motor, behavioral phenomenon.
Complex TAS:
Accompanied by motor, behavioral or Autonomic
Age 5 years to 10 years, history of febrile seizures in only significant.
Simple TAS:
Sudden onset of impaired Consciousness with blank facial stare without other motor, behavioral phenomenon.
Complex TAS:
Accompanied by motor, behavioral or Autonomic
2) phenomenon.
Clonic... May be subtle, like eye-blinking, Nystagmus, jerk of arms.
Tone... Extension or flexion of trunk in case of contractions(increase tone) , head nodding or dropping objects in case decrease Tone.
Automatism... Rubbing face or hand, licking lip, chewing,
Clonic... May be subtle, like eye-blinking, Nystagmus, jerk of arms.
Tone... Extension or flexion of trunk in case of contractions(increase tone) , head nodding or dropping objects in case decrease Tone.
Automatism... Rubbing face or hand, licking lip, chewing,
3) grimacing, scratching.
Autonomic...Pallor, Flushing, salivation, sweating.
Atypical Absences::
Less abrupt onset or cessation, more changes in tone, long duration than TAS, associated with other seizures types & mental Retardation, usually begin before age 5 years,
Autonomic...Pallor, Flushing, salivation, sweating.
Atypical Absences::
Less abrupt onset or cessation, more changes in tone, long duration than TAS, associated with other seizures types & mental Retardation, usually begin before age 5 years,
1) GEFS plus (Genetic Epilepsy with Febrile Seizures plus)
Mildest Benign Form: Normal EEG + IMAGING
1:Simple Febrile Seizures
2:Febrile Seizures Plus
Severe Form: Abnormal EEG + IMAGING
3:Dravet Syndrome
4:Doose Syndrome
Mildest Benign Form: Normal EEG + IMAGING
1:Simple Febrile Seizures
2:Febrile Seizures Plus
Severe Form: Abnormal EEG + IMAGING
3:Dravet Syndrome
4:Doose Syndrome
2) GEFS plus is a genetic syndrome, Defect in 4 Genes, SCN1A, SCN1B, GABRG2, GABRD. Other seizures with FS Or FS-plus are Absence, atonic, myoclonic, and partial.
FS:
Typical convulsive seizures, 6month-6years, with fever 38c' or greater.
FS:
Typical convulsive seizures, 6month-6years, with fever 38c' or greater.
3) FS-plus:
Mild form of generalized epilepsy, different presentations.
1:Febrile Seizures continues past 6 years which is upper limit of FS, than decrease gradually.
2:Febrile Seizures and Afebrile seizures upto typical age for Febrile Seizures.(6 months to 6 years).
Mild form of generalized epilepsy, different presentations.
1:Febrile Seizures continues past 6 years which is upper limit of FS, than decrease gradually.
2:Febrile Seizures and Afebrile seizures upto typical age for Febrile Seizures.(6 months to 6 years).
#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.
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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?
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/
Medications: tacrolimus, infliximab, remicade
3/
(1/7) Lipid Myopathy
1:Carnitine Palmitoyltransferase 2 deficiency
2:VLC acyl-CoA-Dehydrogenase deficiency
3:Trifunctional Deficiency
1:Carnitine Palmitoyltransferase 2 deficiency
2:VLC acyl-CoA-Dehydrogenase deficiency
3:Trifunctional Deficiency
(2/7) Metabolism of fats,Beta-Oxidation, Carnitine.
Excessive accumulation of fatty acids,fatty liver, cardiomyopathy.
Exercise induced weakness, static myopathy, Fasting non-ketotic hypoglycemia, Rhabdomyolysis.
Excessive accumulation of fatty acids,fatty liver, cardiomyopathy.
Exercise induced weakness, static myopathy, Fasting non-ketotic hypoglycemia, Rhabdomyolysis.
(3/7) Labs:
EMG-Myopathic patterns,
BLOOD: lncreased CK, low free carnitine, increased Acylcarnitine, lactate, urinary organic acids,
During Crises ⬆️ CK, Acylcarnitine, myoglobunuria, hypoglycemia, absent ketone formations.
EMG-Myopathic patterns,
BLOOD: lncreased CK, low free carnitine, increased Acylcarnitine, lactate, urinary organic acids,
During Crises ⬆️ CK, Acylcarnitine, myoglobunuria, hypoglycemia, absent ketone formations.
1/10 Mitochondrial Myopathy
A=Muscles:
Symmetric,proximal, ⬆️ CK + Growth Differentiating Factor-15, EMG-Myopathic finding
Biopsy - Cox negative Fibre, Red + Blue ragged Fibres.
A=Muscles:
Symmetric,proximal, ⬆️ CK + Growth Differentiating Factor-15, EMG-Myopathic finding
Biopsy - Cox negative Fibre, Red + Blue ragged Fibres.
2/10 B=Brain:
Ataxia,Dementia,Strokes,Migraine, Dystonia, Mood issues, seizures, Epilepsia partialis (1)
Ataxia,Dementia,Strokes,Migraine, Dystonia, Mood issues, seizures, Epilepsia partialis (1)
3/10 continue(MELAS+POLG) .
MRI Brain,CSF lactat,EEG.
Leigh-Central gray matter,Putamen, caudate, thalamus, cerebellum, midbrain, pons, Medulla, longtracts.
MELAS- Parital +Occipital lobes.(2)
MRI Brain,CSF lactat,EEG.
Leigh-Central gray matter,Putamen, caudate, thalamus, cerebellum, midbrain, pons, Medulla, longtracts.
MELAS- Parital +Occipital lobes.(2)
.@BethDarnall designed the questionnaire widely used to diagnose Pain Catastrophizing (PC). She pinned a survey to her twitter pg, asking people in #ChronicPain what they think of the term. Research on PC & rx #opioids is +75 times higher now than in '00-02.
What's PC? / thread
What's PC? / thread
The Pain Catastrophizing Scale measures "rumination (eg, 'I can't stop thinking about how much it hurts'), magnification (eg, 'I worry that something serious may happen'), and helplessness (eg, There is nothing I can do to reduce the intensity of the pain')." [Darnall note 1]
"Psycho-pathology is both an antecedent & a consequence of persistent pain." [note 2]
Pain catastrophizing is "a mental set related to pain that is characterized by feelings of helplessness and persistent and unrealistic beliefs about pain and its consequences." [note 3]
Pain catastrophizing is "a mental set related to pain that is characterized by feelings of helplessness and persistent and unrealistic beliefs about pain and its consequences." [note 3]
