Discover and read the best of Twitter Threads about #neurotwitter
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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
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
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)
For imaging, subtle distinctions in symptoms usually aren’t provided & many common diagnoses are without imaging findings (BPPV, vestibular migraine)
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.
It's a relatively uncommon etiology of dizziness, but its prevalence increases in emergent/acute dizziness populations
Missed VBI can have profound consequences/morbidity.
Distraught parents bring their son to you. They tell you that he has been having weakness of his left hand since 1 year. With wasting. No sensory symptoms. They have been told, Motor Neurone Disease . You look at his hand and smile reassuringly. Why?
First things first, the demographics don't fit ALS. He's a young boy. Secondly, The disease seems quite restricted. Third, no signs of upper motor neuron disease. Finally, this OBLIQUE AMYOTRPOHY is classical and clinches a diagnosis of HIRAYAMA DISEASE
#MedTwitter #NeuroTwitter
#MedTwitter #NeuroTwitter
Hirayama Disease typically affects young Asian males in their twenties. I have seen dozens of patients with Hirayama, never a girl (although case reports exist)
These boys tend to be lean and have long necks!
It is much more benign compared to ALS!
These boys tend to be lean and have long necks!
It is much more benign compared to ALS!
We need to talk about the role of GABA in mental illness and neurological disorders. And then I am going to explain to you why ketones can help regulate this neurotransmitter. 🧵 (1/21)
GABA (gamma-aminobutyric acid) is the main inhibitory neurotransmitter in the brain, and it plays a critical role in regulating neuronal excitability and maintaining the balance between neuronal excitation and inhibition. (2/21)
GABAergic dysfunction has been implicated in a wide range of psychiatric and neurological disorders, including #anxiety disorders, #depression, #epilepsy, #schizophrenia, and #autism spectrum disorders. (3/21)
Is the wakefulness-promoting, consciousness-enabling influence of the brainstem left-lateralized in humans?
Seems unlikely, right? In 2016 we did a lesion study of coma and our results suggested a left lateralization to a dorsolateral pontine tegmentum arousal-promoting region.
This was a small enough sample I think we all assumed the apparent laterality could have been by chance.
This was a small enough sample I think we all assumed the apparent laterality could have been by chance.
Ever since this paper Joel Geerling (@geerling_lab) and I have been collecting brainstem lesion cases @uiowaneuro in search of counter evidence that would challenge this lateralization hypothesis.
Can you figure out the cause of hemorrhage in this case?
Imaging and case details in thread #Neurosurgery #radres #MedTwitter #Neurology @TheASNR #MedEd #neurotwitter
Imaging and case details in thread #Neurosurgery #radres #MedTwitter #Neurology @TheASNR #MedEd #neurotwitter
Initial MRI shows an expansile enhancing mass in the right parasagittal frontal lobe
The patient underwent craniotomy for tumor debulking. Post operative MRI and CT demonstrate hemorrhage in the right cerebellar hemisphere, far from the operative site. What’s the cause of the hemorrhage? 🤔 🧠
You are again asked to see a patient with GBS. A young man in his 30's, does not seem perturbed by his acute onset of weakness of lower limbs. He says he has been through it on many occasions before. This particular bout was triggered after a hearty meal at a wedding. Thoughts?
An important differential to GBS are the Channelopathies. This gentleman had low levels of Potassium, and correction of the same completely reversed his symptoms! On evaluation, he was diagnosed with a Channelopathy
Simplified Approach
#Neurology
Simplified Approach
#Neurology
Hypokalaemia is notorious to cause neurological weakness often mimicking GBS. However clinical pointers for it are
- Recurrent Attacks
- Triggered by Alcohol/Carbs
- No Bulbar/ Facial Involvement
-Preserved reflexes (Can have areflexia!)
-Rapid (to come and go)
-Normal CSF
- Recurrent Attacks
- Triggered by Alcohol/Carbs
- No Bulbar/ Facial Involvement
-Preserved reflexes (Can have areflexia!)
-Rapid (to come and go)
-Normal CSF
The tides are turning, and people are taking charge of their health like never before! With big pharma falling short, we're in a renaissance of exploring all the ways we can feel better. #metabolicpsychiatry #neurotwitter
Ketone body metabolism has shown promising potential for enhancing wellness and ameliorating disease, including mental illness and neurological disorders.
There's so much more to learn about the power of ketone body metabolism, but the growing interest is an amazing sign for the future of healthcare.
Tina dreaded those 3 days every month
1. 32-year old Tina was happy & cheerful for 27-28 days every month, however, she feared facing the remaining 3-4 days. She hopelessly wished that those days never ever came, but that was not possible.
#medTwitter #neurotwitter
1. 32-year old Tina was happy & cheerful for 27-28 days every month, however, she feared facing the remaining 3-4 days. She hopelessly wished that those days never ever came, but that was not possible.
#medTwitter #neurotwitter
2. Tina used to get severe headaches that occurred only on 3-4 days every month. These days were 1-2 days prior to her menses or during the first two days of menses. She never experienced headache on other days of the month. She had regular periods and had a 2-year old child too.
3. Headaches were severe with a score of 7-8 on visual analog scale (where 10 is the most severe pain, and 0 is absence of pain). Tina had nausea, vomiting and dizziness associated with headache.
Headaches lasted 24-36 hours and they left her completely incapacitated.
Headaches lasted 24-36 hours and they left her completely incapacitated.
1/To call it or not to call it? That is the question!
Do you feel a bit wacky & wobbly when it comes to calling normal pressure hydrocephalus on imaging?
Here’s a #tweetorial about imaging NPH!
#medtwitter #meded #neurotwitter #neurorad #radres #dementia #neurosurgery #FOAMed
Do you feel a bit wacky & wobbly when it comes to calling normal pressure hydrocephalus on imaging?
Here’s a #tweetorial about imaging NPH!
#medtwitter #meded #neurotwitter #neurorad #radres #dementia #neurosurgery #FOAMed
2/First, you must understand the pathophysiology of “idiopathic” or iNPH. It was first described in 1965—but, of the original six in the 1965 cohort, 4 were found to have underlying causes for hydrocephalus.
This begs the question—when do you stop looking & call it idiopathic?
This begs the question—when do you stop looking & call it idiopathic?
3/Thus, some don’t believe true idiopathic NPH exists. After all, it’s a syndrome defined essentially only by response to a treatment w/o ever a placebo-controlled trial.
However, most believe iNPH does exist--but its underlying etiology is controversial. Several theories exist
However, most believe iNPH does exist--but its underlying etiology is controversial. Several theories exist
#ContinuumCase, plot twist edition:
A 28 year old PGY2 neurology resident is asked by her attending to review 2 scans and determine the diagnosis: Alzheimer disease (AD) or dementia with Lewy bodies (DLB).
What should she say, #neurotwitter?🧵
A 28 year old PGY2 neurology resident is asked by her attending to review 2 scans and determine the diagnosis: Alzheimer disease (AD) or dementia with Lewy bodies (DLB).
What should she say, #neurotwitter?🧵
How would you respond?
Her response:
“Dementia is a clinical diagnosis supported by imaging, CSF, and neuropathological biomarkers. But, the disproportionate hippocampal atrophy in Patient B supports a diagnosis of AD.”
“Dementia is a clinical diagnosis supported by imaging, CSF, and neuropathological biomarkers. But, the disproportionate hippocampal atrophy in Patient B supports a diagnosis of AD.”
A teenager referred with "difficult to control" fits needed non-drug approach for controlling fits
1. 15-year old Rishi had been having fits for the past three months. He used to have jerky movements of hands and legs that lasted several hours and occurred 15-20 times per day.
1. 15-year old Rishi had been having fits for the past three months. He used to have jerky movements of hands and legs that lasted several hours and occurred 15-20 times per day.
1a. He was seen by local doctors. MRI brain & EEG were normal.
He was started on anti-epileptic drug (AED). As seizures did not get controlled with single AED, two more drugs were sequentially added. As seizures continued despite giving maximum doses of 3 AEDs, he was referred.
He was started on anti-epileptic drug (AED). As seizures did not get controlled with single AED, two more drugs were sequentially added. As seizures continued despite giving maximum doses of 3 AEDs, he was referred.
2. Rishi had no past history of fits or febrile seizures in early childhood. There was no family history of epilepsy. He was a bright kid, doing well in studies.
While in OPD, I witnessed one of the episodes of fits, which made me suspect the root cause of fits in Rishi.
While in OPD, I witnessed one of the episodes of fits, which made me suspect the root cause of fits in Rishi.
Migraine, a common neurological disorder, may be a metabolic as much as a neurological disease, with the migraine attack serving as a warning signal to increased oxidative stress and/or hypometabolism. (1/21) #neurotwitter #hypometabolism
Despite being primarily studied in terms of neuro-vasculature and neurotransmission, recent research suggests that migraine's pathogenic mechanisms may be linked to metabolism and mitochondrial dysfunction. (2/21) #mitochondria
Magnetic resonance spectroscopy studies have consistently shown decreased ATP levels and abnormal mitochondrial function in migraineurs, suggesting a metabolic component to the disorder. (3/21)
Young boy w/ acute onset quadriparesis with areflexia, admitted to ICU with "GBS". You happen to glance at Urine Bag. something is off! The old urine is darker!? The patient is squealing with abdominal pain. Relatives tell you- seizures in the past
Thoughts?
#MedTwitter
Thoughts?
#MedTwitter
This surely doesn't feel like a routine GBS. Young boy with seizures and abdominal pain, think of the Porphyrias!
Our patient probably has one of the acute Porphyrias. Confirmation of the type eluded us unfortunately since genetic analysis is expensive. Probably AIP
Our patient probably has one of the acute Porphyrias. Confirmation of the type eluded us unfortunately since genetic analysis is expensive. Probably AIP
Neuro Porphyrias include
1. Acute Intermittent Porphyria (AD)
2. Hereditary Coproporphyria (AD)
3. Variegate Porphyria (AD)
4. ALA Dehydrates Porphyria
1. Acute Intermittent Porphyria (AD)
2. Hereditary Coproporphyria (AD)
3. Variegate Porphyria (AD)
4. ALA Dehydrates Porphyria
This is a highly relevant study from Japan on #Dysautonomia, #gAchR antibodies and #FND!
I'll explain why it's important and what it means in clinical terms. 1/🧵
#MedTwitter #NeuroTwitter @Dysautonomia
frontiersin.org/articles/10.33…
I'll explain why it's important and what it means in clinical terms. 1/🧵
#MedTwitter #NeuroTwitter @Dysautonomia
frontiersin.org/articles/10.33…
@Dysautonomia What the study found:
✅ Out of 59 patients who qualified for #FND diagnosis by DSMV criteria, 88% had autonomic symptoms!!!
✅ 27% were positive for ganglionic acetylcholine receptor antibody (gAchR Ab) via LIPS assay.
✅ 50% had #POTS.
✅ 50% had orthostatic hypotension.
2/🧵
✅ Out of 59 patients who qualified for #FND diagnosis by DSMV criteria, 88% had autonomic symptoms!!!
✅ 27% were positive for ganglionic acetylcholine receptor antibody (gAchR Ab) via LIPS assay.
✅ 50% had #POTS.
✅ 50% had orthostatic hypotension.
2/🧵
@Dysautonomia Why is this important?
✅ Our patients are often misdiagnosed with #FND, and this study proves that.
✅ When #FND is diagnosed, treatment is psychotherapy & physical therapy, which is not a treatment for #Dysautonomia.
✅ We MUST identify and treat #Dysautonomia symptoms.
3/🧵
✅ Our patients are often misdiagnosed with #FND, and this study proves that.
✅ When #FND is diagnosed, treatment is psychotherapy & physical therapy, which is not a treatment for #Dysautonomia.
✅ We MUST identify and treat #Dysautonomia symptoms.
3/🧵
Microcytic anemias, which affect all cell lines, can have adverse effects on brain and nervous system health. Iron deficiency #anemia, the most common type of microcytic anemia, can cause #cognitive impairment. 🧵(1/18)
Iron is crucial for #brain function, and its #deficiency can reduce #oxygen delivery to the brain, affecting #cognitive processes like #attention, #memory, and learning. (2/18)
#B12 deficiency, another common cause of microcytic anemia, can also damage the nervous system. (3/18)
2 brothers in their 30’s presented to us with progressive Cerebellar ataxia. On examination, there is slightly restricted vertical gaze.
Thoughts ?
#MedTwiter #NeuroTwitter #Neurology
Thoughts ?
#MedTwiter #NeuroTwitter #Neurology
One of the typical features of Niemann-Pick C disease is SUPRANUCLEAR VERTICAL GAZE PALSY
Ataxia, Dystonia Psychomotor Regression are common
GELASTIC CATAPLEXY is another common feature
Ataxia, Dystonia Psychomotor Regression are common
GELASTIC CATAPLEXY is another common feature
The disease follows an Autosomal Recessive inheritance and unlike A/B, C can present in older ages with neurological features, without hepatosplenomegaly
I'm a collector, a neurology nerd, and a history fan by nature. The result of all of those is that I now own every major type of #neurology reflex hammer, and I've done the work for you to rank them.
Check out my reasoning below.
#neurotwitter #medtwitter
Check out my reasoning below.
#neurotwitter #medtwitter
Tromner (S)
It's simultaneously the Cadillac and the Toyota Camry of reflex hammers. Most (American) neurologists carry one for a simple reason: it's the best. Best length, best weight, pointed tip for Babinski sign... There's really nothing negative to say.
It's simultaneously the Cadillac and the Toyota Camry of reflex hammers. Most (American) neurologists carry one for a simple reason: it's the best. Best length, best weight, pointed tip for Babinski sign... There's really nothing negative to say.
Berliner (A)
Doesn’t get enough love. Has a great weight and pointed tip. It's slightly shorter and thinner so it can fit in your pocket. While the shorter handle and off-balance head are actually advantageous, I can't deny that it doesn't feel as good in your hand as a Tromner.
Doesn’t get enough love. Has a great weight and pointed tip. It's slightly shorter and thinner so it can fit in your pocket. While the shorter handle and off-balance head are actually advantageous, I can't deny that it doesn't feel as good in your hand as a Tromner.
I just want your brain to work well so you can feel amazing. I don't care if you use a ketogenic diet. And for those of you with long-Covid, you may benefit from HBOT treatment. 🧵(1/8)
"Hyperbaric oxygen therapy can improve cognitive function, psychiatric symptoms, pain, and fatigue in patients who have post–COVID-19 conditions. (2/8)
The beneficial effect of the therapy can be attributed to increased brain perfusion and neuroplasticity in regions associated with cognitive and emotional roles." (3/8)
1/Does trying to remember inferior frontal gyrus anatomy leave you speechless?
Do you get a Broca’s aphasia trying to name the parts?
Here’s a #tweetorial to help you remember the #anatomy of this important region
#medtwitter #meded #neurotwitter #neurorad #radtwitter #radres
Do you get a Broca’s aphasia trying to name the parts?
Here’s a #tweetorial to help you remember the #anatomy of this important region
#medtwitter #meded #neurotwitter #neurorad #radtwitter #radres
2/Anatomy of the inferior frontal gyrus (IFG) is best seen on the sagittal images, where it looks like the McDonald’s arches.
To find the IFG on MR, I open the sagittal images & scroll until I see the arches. When it comes to this method of finding the IFG, "i’m lovin it."
To find the IFG on MR, I open the sagittal images & scroll until I see the arches. When it comes to this method of finding the IFG, "i’m lovin it."
3/Inferior frontal gyrus also looks like a sideways 3 on sagittal images, if you prefer.
This 3 is helpful bc the inferior frontal gyrus has 3 parts—or "pars"
This 3 is helpful bc the inferior frontal gyrus has 3 parts—or "pars"
Mitochondria are essential to our overall health and well-being. In addition to producing energy, they regulate many critical processes in the body. (1/11) #mitochondria #energy #health
Mitochondria play a key role in the production and regulation of neurotransmitters. They also help produce key hormones like cortisol, estrogen, and testosterone. (2/11) #mitochondria #hormones #neurotransmitters #neurotwitter
Mitochondria are involved in epigenetics, which is the expression of #genes from the nucleus. They send signals to the nucleus that turn genes on or off. (3/11) #epigenetics #genes #mitochondria
Why social media nutrition activism matters - a short thread ⬇️ A family member with a science degree was stunned to know about the sources of vitamin B12 .
I posted multiple stories about the animal sources of vitamin B12 on WhatsApp status. I love to use Canva & Adobe Express to make stories about cobalamin. I also explained that processed foods such as Kellogs cornflakes, Chocos, Horlicks, Boost, Marmite, etc have vitamin B-12.
So this gent met me in person the same day. Looking at my status on his phone, he asked, "Is this verified news?" I was wide-eyed. Here was an engineer who had biology till class 12. He had completely forgotten that we had learnt about the animal origin food sources of vitB12.
I educate on ketogenic diets for mental illness & neurological disorders because I want you to know all the ways you (or a loved one) can feel better. 🧵(1/4)
Learning all the ways you can feel better helps you understand that you deserve better treatment options than you are currently being offered. (2/4)
Learning all the ways you can feel better means that you no longer feel like you have to suffer in silence because you are already receiving a standard of care that is not working well for you. (3/4)
Young woman with unexpected cause of repeated bouts of vomiting
1. 1999: It was another busy day, when I had seen 60 outpatients, worked up & written case notes for 8 ward admissions and had finished seeing 14 consultations (from other depts). It was 2 AM and I needed some sleep.
1. 1999: It was another busy day, when I had seen 60 outpatients, worked up & written case notes for 8 ward admissions and had finished seeing 14 consultations (from other depts). It was 2 AM and I needed some sleep.
2. Residency at CMC Vellore in 90s was tough, which denied even 4 hours of sleep on many nights. Got a call from Gastro ward regarding a 25-yr old woman who had repeated episodes of vomiting for one week. Detailed evaluation by gastro dept could not identify the cause of vomiting
3. Neurology opinion was sought to rule out neuro-related causes of vomiting (such as cyclical vomiting syndrome, brain-stem lesions, migraine, etc).
I took a detailed history. She had no symptoms other than vomiting. On examination, she was dehydrated and looked weak.
I took a detailed history. She had no symptoms other than vomiting. On examination, she was dehydrated and looked weak.
1/Having trouble remembering how to differentiate dementias on imaging?
Here’s a #tweetorial to show you how to remember the imaging findings in dementia & never forget!
#medtwitter #meded #neurorad #radres #dementia #alzheimers #neurotwitter #neurology #FOAMed #FOAMrad #PET
Here’s a #tweetorial to show you how to remember the imaging findings in dementia & never forget!
#medtwitter #meded #neurorad #radres #dementia #alzheimers #neurotwitter #neurology #FOAMed #FOAMrad #PET
2/The most common functional imaging used in dementia is FDG PET. And the most common dementia is Alzheimer’s disease (AD).
On PET, AD demonstrates a typical Nike swoosh pattern—with decreased metabolism in the parietal & temporal regions
On PET, AD demonstrates a typical Nike swoosh pattern—with decreased metabolism in the parietal & temporal regions
3/The swoosh rapidly tapers anteriorly—& so does hypometabolism in AD in the temporal lobe. It usually spares the anterior temporal poles.
So in AD look for a rapidly tapering Nike swoosh, w/hypometabolism in the parietal/temporal regions—sparing the anterior temporal pole
So in AD look for a rapidly tapering Nike swoosh, w/hypometabolism in the parietal/temporal regions—sparing the anterior temporal pole
