Discover and read the best of Twitter Threads about #neurology

Most recents (24)

Med Schools offer almost no instruction in the world's #1 cause of working-age disability. It'd be like Dental Schools not covering cavities.

7 words diagnose most #migraine: Recurrent #pain w/ hypersensitivity &/or nausea. 60% of patients go undiagnosed. #MedicalTwitter #PCP
#Migraine is PROGRESSIVE. A 40% diagnostic rate condemns some to lifelong #disability: Late diagnosis & ineffective treatment of acute #migraine are leading risks for continuous migraine. #PCP #MedicalTwitter mdedge.com/jcomjournal/ar…
🔴HOW DOES THIS CHILD GO 8 YEARS WITHOUT A DIAGNOSIS? She has textbook ICHD-3 #migraine! 1>sudden hypersensitivity (smell) 2>throbbing #pain 3>nausea 4>need for bedrest

She might've avoided #disability w/ early diagnosis & treatment. #PCP blogs.webmd.com/my-experience/…
Read 10 tweets
1/ In #COVID19, we must learn from #BRAIN masters Engel & Romano, who described #DELIRIUM to #DEMENTIA relationship in the 1950s! Here are my TOP 10 CLASSIC quotes from their famous 1959 article:
bit.ly/2SePA1a
 
#medtwitter #meded #tipsfornewdocs #neurology #geriatrics Image
2/ The problem of delirium is far from an academic one. Not only does the presence of #delirium often complicate and render more difficult the treatment of a serious illness, but also it carries the serious possibility of permanent irreversible brain damage.
 
#dementia #COVID
3/ The deficiencies in the education of many physicians ill equip them to recognize any but the most flagrant examples of delirium.
 
#A2Fbundle #tipsforolddocs
Read 12 tweets
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.
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.
3) 3::Sensory Changes...
Photo, phono, osmo, Phobia, nause, neckstiffness.
Read 7 tweets
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.
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.
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.
Read 12 tweets
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
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,
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,
Read 12 tweets
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
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.
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).
Read 10 tweets
#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.

1/ Image
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?
See image for details of event and vital signs

Medications: tacrolimus, infliximab, remicade

3/ Image
Read 15 tweets
Q: Doc, doc there’s a patient with sudden onset shoulder pain which worsened precipitously over a couple of hours after recovering from the flu. What should we do?
A: Sounds like a typical history for Parsonage Turner Syndrome. You suspect this when there’s acute onset really severe shoulder pain after an infection, operation, pregnancy or vaccination.
Read 15 tweets
As we read #EEG studies, we look for specific brainwave patterns and rarely stop to think about the molecular/cellular events that are taking place to yield each component of the recording. This thread is a reminder of that! #MedEd #twEEGtorial #tweetorial #Neurology
1/
My favorite example is the focal epileptiform discharge. We’re very good at detecting focal spike/sharp waves on routine surface EEG studies. So good that we can train machines to teach themselves to recognize them fairly accurately! E.g. jamanetwork.com/journals/jaman…
2/
But what is a spike/sharp wave saying about underlying brain events? Let me take you from scalp to cell, step by step. Here’s a surface recording in longitudinal bipolar with LFF = 1 Hz, HFF = 70 Hz, S = 7 uV/mm, t = 30 mm/sec.
3/
Read 19 tweets
1/4
43yr chronic #alcohol user on Liv.52 #Herbal supplement for 1yr. Believes Liv52='hepatoprotective'. Consumes along with to cancel alcohol-toxicity. Diabetes uncontrolled on #Ayurveda. Comes with #jaundice, severe #headache, eyes 'bulged' 2 days, nasal discharge #livertwitter Image
2/4
At admission, #seizures, uncontrolled, put on #ventilator. Deep jaundice, comatose. Investigations=acute on #chronic liver failure #aclf
#MRI Brain Part 1👇
Extensive hemorrhagic infarcts, almost all of anterior and mid #brain.
#medicine #MedTwitter #radiology Image
3/4
MRI Brain Part 2👇
Both sides cortical venous thrombosis and anterior third of superior saggitsl sinus thrombus.
#imaging #stroke #NeuroTwitter #neurology #NeuroTwitterNetwork Image
Read 5 tweets
Q: Doc, doc, got a 35 year old chap in for terrible muscle aches after running a race. He says his urine is black. What could it be?
A: Black urine suggests myoglobin. What’s his CK? Is it elevated together with other muscle enzymes (AST, ALT, Aldolase)? If so, think rhabdo. Now the question is whether he’s got a provoked attack or has underlying genetic susceptibility.
Read 22 tweets
(1/7) Lipid Myopathy
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.
(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.
Read 9 tweets
1/10 Mitochondrial Myopathy

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)
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)
Read 13 tweets
Time again for #NeuromuscularQandA? RT. #neurology #medtwitter#MedEd #medstudent#neurologyresident Join me in discussing/learning/educating with #passion and #humor@WNGtweets @MonicaDhakar @MadSattinJ @NinaRiggins @AaronLBerkowitz @RachelSalasMD
@Tracey1milligan @DxRxEdu
Q: Doc, doc. The limb girdle muscular dystrophies (LGMDs) are giving me a headache. Too many, too many, can’t you simplify them pretty please?
A: Your wish is my command. Let’s think about common presentations. Are there early contractures? Is there calf hypertrophy? Is there calf atrophy? Is there cardiomyopathy? Is there scapular winging? Is there facial weakness?
Read 25 tweets
2017 Review: “Expert guidelines recommend reducing or discontinuing long-term #opioid therapy when risks outweigh benefits, but evidence on the effect of dose reduction on patient outcomes has not been systematically reviewed.” / #cpp thread.
🟠 How can guidelines be "expert" recommendations if researchers haven't carefully investigated how patients will react when their rx #opiod med is stopped or reduced?

Are we going to feel better or worse? Are we going to live or die?
In 2017, #VA-funded researchers identified 67 studies about #opioid dosage reduction or discontinuation.

Study quality was deemed “poor” in 76% of the 67, the lowest rating.
Read 21 tweets
Q: Doc, doc, got a middle-aged patient with subacute onset of proximal muscle weakness and CK of 10K. What could it be?
A: Any cutaneous or joint or respiratory issues? If it’s just muscle, it might be necrotizing autoimmune or toxic myopathy with that level of CK.
Read 19 tweets
Strange cause for #cirrhosis
Maybe very #rare #MedEd
53yrs man, voice change, recurrent headaches, male breast enlargement. Stops socialising. Has bleed one day, #endoscopy varices, #biopsy fatty liver cirrhosis
No metabolic syndrome.
MRI Brain done. #livertwitter #radio
1/3 Image
What is the diagnosis?
In patients with cirrhosis, always try to find the cause in those who present early. There is no idiopathic, no cryptogenic. Its all 'missed' cirrhosis.
2/3 #liverpath
#MedTwitter #pathology #radiology #MRI #brain #Neurology #Endocrinology #NeuroTwitter Image
#diagnosis: #fatty liver related cirrhosis due to #pituatory macro adenoma with high prolactin, high GH, low #thyroid function. #clinical examination, acromegaly features with central obesity. #Examine 1st, then investigate. #MedicalStudent #medicine #MedStudentTwitter
3/3
Read 4 tweets
Q: Doc, doc, have a patient with subacute weakness and suspected myositis. Why in the world are we considering these humongous panels of autoantibodies? Can’t we just do a muscle biopsy?
A: Just 2 reasons - diagnosis and prognosis. We send myositis specific antibodies (MSA) and myositis associated antibodies (MAA). MSA are antibodies specifically associated with inflammatory myopathies.
Read 16 tweets
Antibiotics are commonly prescribed medications in the inpatient and outpatient setting and it's important to recognize #AdverseEvents, including idiosyncratic reactions, such as #encephalopathy.

2/
Antibitiotics associated with #Encephalopathy:
- Beta lactams
- #Cephalosporins (#Cefepime is the most common,
Ceftazidime)
- Imipenem
- #Penicillin procaine
- Fluoroquinolones
- Macrolides (clarithromycin)
- TMP-SMX
- #Metronidazole
- Isoniazid

3/
Read 14 tweets
#Tweetorial! Join me on a saga through history and the fields of #Neurology #Neurosurgery and #Pathology! This was prompted by Neuropathology rounds today with @StewartGNeill

"Foix-Alajouanine Syndrome"

@MedTweetorials #MedEd
1/
"Gesundheit" was my first thought when @StewartGNeill said "Foix-Alajouanine" but some reading turned up some interesting facts about this eponym..

2/
Charles Foix was a French internist and neurologist. A student of Pierre Marie (who was an assistant to Jean-Martin Charcot) at Salpêtrière, Foix later taught alongside Georges Guillain.

3/
Read 21 tweets
Cranial nerve testing as emojis. Comment if you have additions/suggestions! #neurotwitter #MedTwitter #WorldEmojiDay #Neurology

CN I
👃
☕️

CN II
🔠🔡 🔠🔡
2️⃣0️⃣/2️⃣0️⃣

👁
🔭🤏

🔦↔️🔦
👁 👁

✌️ ✌️☝️ ☝️
👁 👁
☝️ ✌️☝️ ✌️

📍 📍
CN III/IV/VI
↖️ ⬆️ ↗️

⬅️ 👆👀 ➡️

↙️ ⬇️ ↘️

👍
↕️
👍 ↔️ 👀☝️ ↔️ 👍
↕️
👍

CN V
🧷+👆+🧊
👉 👈
👉 😐 👈
👉 👈

😬

👁👈😭

😦🔨

CN VII
😯
😣
😚
😃

2️⃣/3️⃣:🧂& 🍯➡️👅
CN VIII
🎵👂

CN IX/X
😩🔦

👄👈🤮

🗣

(IX) 1️⃣/3️⃣:🧂& 🍯➡️👅

CN XI
🤷
🌛🌜

CN XII
⬅️👅➡️
⬇️
Read 3 tweets
#Tweetorial time! A little late this week as I’ve been busy on inpatient. Transitioning to #CommonNeuroConsults and this week will start with a #stroke and #ophthalmology topic @DGlaucomflecken @MedTweetorials #meded #medstudenttwitter

“Transient Monocular Vision Loss”
1/
You may also hear this called “amaurosis fugax” and can be due to an ocular cause, a vascular cause, or an optic nerve head problem!
2/
Let’s start with a brief review of ocular and oculovascular anatomy!

Your optic nerve is cranial nerve 2. This is the nerve that transmits visual information from the retina to the visual cortex.
3/ Image
Read 18 tweets
- Make an initial list of programs you are interested in applying to.
- Do your #research: curriculum, front loaded?, number of residents, night float?, location, categorical or advanced (needs IM prelim)?
- Start asking for LoRs (May have to remind writer at least once)

2/
- Start working on your PS
- Have a note or document on your phone/PC for
ideas: You never know when a moment of inspiration
may happen!💡).
- Make as many corrections as needed
- Contact programs with any questions, specially if something is not clear to you

3/
Read 9 tweets
Currently reading a study with one of my favorite findings, so let's play an EEG game:

If I will report this as "normal," what is the OLDEST this patient can be? Vote in the next tweet 👇! #Tweetorial to follow #MedEd #neurology #MedTwitter #FOAMed
[Expand tweet to reveal poll if options not showing]

For this study to be normal, the patient must be UP TO:
Bonus question 👇🤓[again, might need to expand tweet to see the options]

Based on the finding above, What is the YOUNGEST this patient must be? CA = postconceptional age
Read 15 tweets

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