Discover and read the best of Twitter Threads about #neurology

Most recents (24)

1/ Time for another illustrative learning case in the form of a 🧵#tweetorial #medtwitter #neurotwitter #neurocriticalcare #neurology. Case deidentified as always
2/ Young human with no medical history but IVDA (heroin, cocaine, PCP) with multiple prior overdoses and recent discharge from drug rehab 2 days prior who presents to #ED after acting funny
3/They were noted to be lethargic, GCS 13, not able to provide history. CT demonstrates cerebellar edema with #hydrocephalus (💧) and some ⬆️ transtentorial 🧠 herniation
Read 21 tweets
. 🦠#COVID19 ⚠️F*CKing⚠️with the
brain🧠and body
of this 15 year-old boy. Real badly.… #WomenInSTEM #openscience #scicomm #snrtg #immunology #neurology
COVID-19 is NOT "just like the flu."
COVID-19 is NOT "just like the flu."
COVID-19 is NOT "just like the flu."
"Cerebellar examination revealed impaired finger to nose, heel to shin, and rapid alternative movements. Gait was ataxic and he could not walk without help."
* in a previously healthy young man
Read 8 tweets
1) Have you ever seen a case of rabies?

I saw two cases 5 years back and they have stayed with me since.

I do not fear any disease per se but I am not ashamed to say that I dread rabies --> it is a terrible affliction.
2) The first patient was a small child of around 7 years old --> he had been bitten by a street dog around 1 month back. But his family had opted for natural healers.

When he was brought in, he was crying uncontrollably with a terror stricken expression on his face.
3) Hydrophobia, as commonly believed, is not so common in these cases. Why you ask?

Its because these patients are so extremely agitated and combative, its very difficult to get close to them, let alone make them drink water.
Read 16 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
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
re: ICH Prevention in People w ⬆️Risk MRI findings in @American_Heart updated 2022 ICH guidelines🧠🩸

📌 Refers to incidentally found MRI markers of small vessel disease (SVD) - a common question

Prompted by @interneurona unpacking below (short 🪀)
For context:
🚫MRI is not routinely done for risk stratification of first-ever spontaneous ICH risk

🔮MRI is occasionally available in certain people/pts w/o ICH: may show SVD markers concerning for future ICH risk

〽️These markers are: microbleeds, superficial siderosis

The populations that this might be relevant to are:
- healthy elderly
- ischemic stroke
- memory clinic
- any pt who got a brain MRI for a different indication (e.g. migraines)
- non-ICH cerebral amyloid angiopathy (CAA)

#neuroradiology #Alzheimers #stroke

Read 12 tweets
Hi #MedTwitter #MedStudentTwitter #neurotwitter #MedEd #FOAMed! It's been too long since my last #EndNeurophobia #tweetorial so here's an introduction to brain imaging–thanks @sarrovasta for the request!🧠❤️
cc:@CPSolvers @rabihmgeha @DxRxEdu @AvrahamCooperMD @caseyalbin
Let's start w/CT. I'll focus on brain (and not bone or soft tissue). First:

* Identify normal structures and any abnormalities in:
- Size
- Shape
- Symmetry
(note *symmetric* abnormalities such as ventriculomegaly or diffuse cerebral edema may not be obvious w/o experience)


* Identify abnormalities
- Hypodensity
- Hyperdensity


• Hypodensity:
- Ischemia
- Inflammation
- Infection
- Neoplasm

• Hyperdensity:
- Blood
- Calcification
- Hyperdense tumors (e.g. lymphoma)
- Thrombus in vessel
- Contrast enhancement

Read 19 tweets
Learning brainstem #neuroanatomy would be nearly impossible without the rule of 4s. I'm going to pass this along for anyone trying to learn #neurology, as this might be the single most powerful mnemonic I know of.

I present to you, The Rule of 4s: a #MedEd #tweetorial

4 cranial nerves per brainstem level
- Midbrain: 1-4
- Pons: 5-8
- Medulla: 9-12

* CNs 1 and 11 do not connect with the brainstem
* CN5 enters in the pons, but has nuclei at all three levels

4 lateral (side) structures, all with an "S":
- Spinocerebellar pathway
- Spinothalamic pathway
- Sensory nucleus of CN5
- Sympathetic pathway

Read 10 tweets
Differential diagnoses of ⛈️Thunderclap headache⚡ are indeed thunderous.

Here is a brief 🧵.

@AaronLBerkowitz @caseyalbin @rabihmgeha @DxRxEdu @sargsyanz @AnnKumfer @rav7ks @gabifpucci @jackpenner @RosenelliEM @Sharminzi @CPSolvers

#MedTwitter #NeuroTwitter #Neurology
#1 Subarachnoid hemorrhage

Aneurysmal SAH
Cortical SAH (due to RCVS)

- Seizures
- Meningismus
- Altered mental status
- RBC & Xanthochromia in CSF

Look out for possible
sequelae: Rebleeding, vasospasm & ischemia, hydrocephalus

#MedTwitter #Neurology…

-Multifocal multivessel vasoconstriction (string of beads)
-Recurrent episodes (triggers- bathing, Valsalva, bending, urinating, strong emotions)

Risk factors: Postpartum state, SSRIs, Calcineurin inhibitors, vasoactive drugs, sympathetic overactive states

Read 11 tweets
I'll be adding short important points which would hopefully help in remembering certain concepts during #PLAB preparation, to this thread🧵every now and then as I take them out from my scattered notes. Feel free to comment your tips and tricks which would help others, as well 👇
Please don't take any of these as medical advice 😂🙏. Real life stuff is much more nuanced. These are just clinchers for the sake of the exam.
1. Drug contraindications...
-Avoid BAN drugs in Asthma (Beta blockers, aspirin, NSAIDS) &
-DAMN drugs in diarrhoea (Diuretics, ACEIs, Metformin, NSAIDs)
Read 60 tweets
Neurocovid tidbits from the annual neurology conference. Standing room only for this lecture.

Virus presumably enters brain via cribriform plate
But despite lots of viral particles in the nasal mucosa multiple brain biopsy studies show no viral particles in brain.
Congested blood vessels and microhemorrhages seen in brain

7T MRI studies shows thickened vessel walls, clots and microhemorrhages in sane vessel

11T MRI studies of pons found high levels of fibrinogen deposition and activated platelets, macrophages leading to neuronophagia
PECAM 1 staining shows activated endothelial cells (endothelial injury) but also deposition of IgG and IgM hence thought to be immune mediated.

Many have antiphospholipid antibodies.

Vestibular symptom immune mediated vasculitis.
Read 8 tweets
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…. Faculty disclosures are listed at
Read 41 tweets
🚨 🧵 Some pearls on cases I have seen last week during night call @bmcneurology @The_BMC 🧠
PRES, RCVS, Trigeminal autonomic cephalalgia, vertigo, IIH, hyperglycemic hyperosmolar syndrome, hyperK, SAH, a tone of CODES STROKE, a tone of seizures
#NeuroTwitter #MedEd #Neurology
⚡️huge spectrum
⚡️high index of suspicion in ptns with risk factors (often with HTN urgency, immunosuppression, sepsis) + seizures
🕵🏻‍♂️may not be posterior, may not be reversible, may not present as a syndrome!! @PulmCrit
-observe (MRI, CTA), remove triggers, be cautious not to miss a dissection @interneurona
-pain control, this is the worst imaginable pain: Mg IV, opioids
-CaCB may help with headache - no proved benefit for vasoconstriction
@AneeshSinghalMD @CajalButterfly
Read 10 tweets
What's the best strategy for effective - and time efficient - teaching in clinic?

A 🧵 for 4⃣ teaching strategies when 🕗 is limited (& how they might be used in #neurology)

#MedEd #NeuroTwitter
1⃣ One-minute preceptor (initially called: 5-step microskills)

5 steps & examples 👇

✅ Assess learner's knowledge
✅ 👍 & constructive feedback "built in"
✅ Clinical reasoning
✅ Good for novice learners

⛔️ "1 min" is a bit unrealistic

✅ Very learner-driven
✅ Aligns well w/ traditional presentation model
✅ Clinical reasoning

⛔️ May not work as well for novice learners
Read 7 tweets
It gives my great pleasure to announce the release of THE PLEXUS, a new strategy card game about peripheral nervous system localization.

Folks, this may be our only hope to #endplexusphobia!

Click here ➡️

And open the 🧵for more surprises.
It’s a 2-3 player game that takes about 20 minutes🕓 to play. And here's the kicker: It's actually fun, and you don’t need to be be a master of brachial plexus anatomy to enjoy it. (In fact, my middle school-age son beat me the first time he played.😯)
I’m selling these at cost from The Game Crafter,…
and I will donate $3 to the American Neuromuscular Foundation for every copy sold in 2022!
@AmNmFoundation @AANEMorg @aanem @ShirlynAdkins
Read 7 tweets
I just went through what my doctors referred to as "long COVID brain fog". It is a surreal and completely debilitating experience, which robs you of basic fundamental cognition and puts you in a delirious state of complete confusion devoid of emotion and self awareness. #COVID19
I would wake up lucid, but after a few hours my mind would drop in the fog. It's tricky to explain, but the individual in your mind that maintains your agency, your personality, your desire, and your purpose in life becomes disconnected. You become a walking robot potato.
I could recollect any info you asked of me. Birthday, phone number, current president... Which made my doctor's very confused when I told them I wasn't feeling lucid.

But, my fundamental understanding of WHY I am here, and the context of my relationship with someone was severed
Read 109 tweets
#Cefalea Puntos claves: anamnesis y examen clínico inicial.
∙ Evaluar gravedad: puede ir desde leve a alta intensidad (“la más grave de la vida del paciente”). Este último grado de intensidad puede apreciarse en cefalea tipo “trueno” u otros tipos de cefalea de altísima intensidad y brusca aparición y necesita atención prioritaria.
∙ Antecedentes: hay que hacer énfasis en el estado de inmunosupresión del paciente, especialmente en presencia de cáncer o infección por virus de inmunodeficiencia humana (VIH).
Read 11 tweets
2. After Erb & Westphal described muscle stretch reflexes in 1875, chest percussion hammers were used to elicit reflexes. This is a Vernon percussion hammer, the precursor of the Queen Square reflex hammer. This one was made by Whitelaw (Aberdeen, Scotland). Image
3. This Wintrich percussion hammer was modified to allow sensation testing and so was likely used to check reflexes. ImageImage
Read 15 tweets
1/ Antiepileptic drugs: a constantly evolving frontier- like many other fields in #Neurology. It’s hard to know about every single medication in-depth. Here, I attempted to make AEDs simple, easy to understand and a handy layout of important facts to know about #AED #epilepsy.
2/ Let’s begin with understanding what is synapse and how it works, then only we can understand how the AEDs work. Look at the cartoon I created from references (acknowledged at the end) with help of an amazing app #Procreate. I’m a fan of @PeterMLawrence1 great art work !!
3/ Looks chaotic?Let’s break it down. You got this!
There are 2 main types of synapses.
A)Excitatory synapse-neurotransmitter is Glutamate- receptors are AMPA and NMDA
B)Inhibitory synapse-neurotransmitter is GABA-receptor is GABAa binding site on ligand gated Cl- channel
Read 24 tweets
Time for a #CriticalCare #Tweetorial!

‼️Basics of CRRT for the non-nephrologist‼️

Exiting my typical #Neurology wheelhouse as I tackle some #FOAMcc topics for my own learning. Please join in on teaching and address any mistakes!

CRRT- What does it stand for?!

Continuous- Runs around the clock (sort of)
Renal- The beans!
Replacement- More of a rinse than a true replacement
Therapy- It helps!

@criticalbeansmd @EmoryNeuroCrit @caseyalbin @KrafteKraft4 @mallyaa @VijayanMD
Why do we use CRRT instead of HD?

Patient’s with hemodynamic instability (ie blood pressure is so low they can’t tolerate HD)

Conditions where you need to avoid large fluid shifts (like cerebral edema)

Read 21 tweets
Time for a #tweetorial on one of my favorite topics: Wrist Drop. @AANMember @NMatch2022 #neurology #futureneurologist #neurotwitter #neurotwitternetwork @AANEMorg #meded @KoriPoRodri

The first thing you should think of when you see a patient with weak wrist extension is…
This. Compression of the radial nerve at spiral groove. And usually, we think of it as being caused by... Image
This. And by the way, if you’re ever curious about the surprising origins of the term “Saturday Night Palsy,” read this article.

But I digress. The spiral groove (aka radial groove) is not the only peripheral localization for wrist drop. Image
Read 11 tweets

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