Discover and read the best of Twitter Threads about #stroke
Most recents (24)
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.
#MedTwitter
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.
#MedTwitter
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.
#neurotwitter
After 10 min, he used to have complete recovery from numbness and tingling.
#neurotwitter
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.
The history was very typical of a neurological problem. Clinical examination was normal. I asked for appropriate investigations.
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.
#stroke
#LongCovid
#LongCovidBrainDamage
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.
#stroke
#LongCovid
#LongCovidBrainDamage
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.
Everything.
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.
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.
My brain's ravaged from #strokes & Covid.
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.
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)
🚨Portland EMS 911: -scanner
10:25AM -12:33PM (Under 2 hrs)
Stroke
Chest pain / Cardiac
Possible death
Chest pain / Cardiac
Seizure
Unconscious
Chest pain / Cardiac
Death
Cardiac arrest
Overdose
10:25AM -12:33PM (Under 2 hrs)
Stroke
Chest pain / Cardiac
Possible death
Chest pain / Cardiac
Seizure
Unconscious
Chest pain / Cardiac
Death
Cardiac arrest
Overdose
🚨Portland 911: -scanner
8:00PM - 8:59PM
Cardiac arrest
Fainting/ Collapsed
Chest pain
Unconscious
Chest pain
Cardiac arrest
Cardiac problem
CPR
The new normal #Cardiacarrest #heartattack #EMS #911
8:00PM - 8:59PM
Cardiac arrest
Fainting/ Collapsed
Chest pain
Unconscious
Chest pain
Cardiac arrest
Cardiac problem
CPR
The new normal #Cardiacarrest #heartattack #EMS #911
Portland 911: 3 reported #Siezures in under 30 minutes. The new normal. #cardiacarrest #heartattack #stroke #seizure #diedsuddenly
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
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
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:
If you need a review: here’s my tweetorial on ASPECTS:
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
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
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.
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.
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.
An elderly man who repeatedly kicked the woman ahead of him while waiting in queue to board a flight
1. 69-year old Balu, while waiting to board a flight, started to repeatedly fling his right leg that hit the woman standing in front. The woman was shocked with this incident.
1. 69-year old Balu, while waiting to board a flight, started to repeatedly fling his right leg that hit the woman standing in front. The woman was shocked with this incident.
2. She was terribly upset and remarked-"just because boarding is delayed & you are restless, doesn't mean you can kick me like that. Moreover, you can't take advantage of you being older to me".
But Balu denied any wrongdoing and said the leg started shaking without his control.
But Balu denied any wrongdoing and said the leg started shaking without his control.
3. As soon as Balu landed in Hyderabad, he consulted a physician, who diagnosed focal motor #seizures (fits) and started him on anti-epileptic drugs (AEDs). Similar symptoms repeated after one month despite being on regular AEDs, and he was referred for my opinion.
#Medtwitter
#Medtwitter
Moderate-to-heavy #alcohol consumption increases the risk of #stroke in #younger adults
1. Alcohol consumption is one of the important modifiable risk factors for stroke in young adults.
A study was conducted in Korea to determine the association between alcohol & stroke.
1. Alcohol consumption is one of the important modifiable risk factors for stroke in young adults.
A study was conducted in Korea to determine the association between alcohol & stroke.
2. Of 1536668 patients (mean age 29.5 years, 71.5% male, and median follow-up of 6-years), 3153 experienced an incident stroke (incidence rate, 0.37 per 1,000 person-years).
Adults who consumed more than 105 g/week of alcohol had higher risk of stroke, especially brain hemorrhage
Adults who consumed more than 105 g/week of alcohol had higher risk of stroke, especially brain hemorrhage
3. Conclusion
Young adults who engaged in moderate-to-heavy drinking demonstrated a higher risk for incident stroke, especially hemorrhagic stroke
n.neurology.org/content/100/5/…
Young adults who engaged in moderate-to-heavy drinking demonstrated a higher risk for incident stroke, especially hemorrhagic stroke
n.neurology.org/content/100/5/…
Canadian guidance on #alcohol consumption
(January 2023)
1. Young people should delay alcohol use for as long as possible.
2. Individuals should not start to use alcohol or increase their alcohol use for health benefits.
3. Any reduction in alcohol use is beneficial.
(January 2023)
1. Young people should delay alcohol use for as long as possible.
2. Individuals should not start to use alcohol or increase their alcohol use for health benefits.
3. Any reduction in alcohol use is beneficial.
4. When pregnant or trying to get pregnant, no amount of alcohol is safe
5. When breastfeeding, not drinking is safest
6. Consuming no drinks is associated with better health & better sleep,
7. Three to six drinks/week raise the risk of developing breast, colon & other cancers
5. When breastfeeding, not drinking is safest
6. Consuming no drinks is associated with better health & better sleep,
7. Three to six drinks/week raise the risk of developing breast, colon & other cancers
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.
1a) Welcome to a new #accredited #tweetorial, “MOA and Clinical Trial Data for Novel & Emerging Therapeutic Strategies for #HCM: Can We Target Our Therapy?"
1b) Our expert (and returning @cardiomet_ce) author is Giuseppe Galati MD, MMSc in Heart Failure, FHFA, @GiuseppeGalati_ , Consultant #Cardiologist #HeartFailure & #Cardiomyopathies
2) @GiuseppeGalati_ is in Milan 🇮🇹 This program is intended for #healthcare professionals & is accredited for 0.75h CE/#CME credit for #physicians #physicianassistants #nurses #nursepractitioners #pharmacists.
‼️Breaking:
@WHO und @US_FDA haben ein Sicherheitssignal (VSD) entdeckt das die Altersgruppe ü-65 und den bivalenten Booster von @BioNTech_Group betrifft und einen Zusammenhang mit Schlaganfällen (Ischämischer Hirninfarkt) nach Impfung untersucht.
1/X
@WHO und @US_FDA haben ein Sicherheitssignal (VSD) entdeckt das die Altersgruppe ü-65 und den bivalenten Booster von @BioNTech_Group betrifft und einen Zusammenhang mit Schlaganfällen (Ischämischer Hirninfarkt) nach Impfung untersucht.
1/X
Verglichen wurde der Zeitraum 0-21 Tage post Impfung mit 22-44 Tagen.
‼️Beim Bivalenten Impfstoff von @moderna_tx trat kein „vorläufiges Signal“ auf.
Das @CDCgov erklärt zu dem Vorgang:
2/X
‼️Beim Bivalenten Impfstoff von @moderna_tx trat kein „vorläufiges Signal“ auf.
Das @CDCgov erklärt zu dem Vorgang:
2/X
1. Andere Faktoren (confounding Factors) können das VSD Signal beeinträchtigt haben.
2. wichtig sei dass kein anderes Safety-system ein Signal gefunden hat.
3. Multiple Verifizierungen/Studien zu dem Thema zeigten die Sicherheit der BNTX Imfung auch bei ü-65 Jährigen.
3/X
2. wichtig sei dass kein anderes Safety-system ein Signal gefunden hat.
3. Multiple Verifizierungen/Studien zu dem Thema zeigten die Sicherheit der BNTX Imfung auch bei ü-65 Jährigen.
3/X
1. Arti to me "Dr, when will my husband Anuj start talking & walking?" Her two kids aged 3 & 5 were holding her hands, as Anuj was brought into my OPD for review one month after suffering brain hemorrhage. Anuj had become paralysed on right side and lost his speech due to stroke
2. Anuj, aged 33, had first consulted me three years ago for headache. On evaluation, his BP was 160/110 mmHg. On enquiry, he had a hectic work schedule of 13-14 hours per day and on an average he slept 4-5 hours/night. His job required out-station travelling on 10-15 days/month.
3. As per Anuj "I have breakfast in Hyderabad, lunch at Mumbai & dinner at Cape town. It is rare for me to have all 3 meals in the same city. I am a valuable employee of the multi-national company that I work for and 300 staff work under my leadership. I earn a handsome salary."
#Indian patients with ischemic #stroke are 19 years younger than British
1. In a recently published research paper, the mean age of ischemic stroke patients in India was only 52 years as compared to 71.5 years in #British.
Ref:doi.org/10.1111/ene.15…
#MedTwitter #neurotwitter
1. In a recently published research paper, the mean age of ischemic stroke patients in India was only 52 years as compared to 71.5 years in #British.
Ref:doi.org/10.1111/ene.15…
#MedTwitter #neurotwitter
2. Even among British, Stroke patients of South Asian ethnicity were 9 years younger as compared to White British.
*Ethnicity is an independent predictor of early age of stroke onset.
*Ethnicity is an independent predictor of early age of stroke onset.
3. Risk factors such as hypertension, atrial fibrillation, ischemic heart disease, alcohol use & obesity contributed to strokes occurring at younger age in Indians.
Consuming carbohydrate-rich diet and lack of physical activity were other risk factors for stroke among Indians.
Consuming carbohydrate-rich diet and lack of physical activity were other risk factors for stroke among Indians.
#PhysicalActivity and #brain health in patients with atrial fibrillation
1. Vascular brain lesions, such as ischemic infarcts, are common among patients with atrial fibrillation (AF) and are associated with impaired cognitive function.
#MedTwitter #neurotwitter #dementia
1. Vascular brain lesions, such as ischemic infarcts, are common among patients with atrial fibrillation (AF) and are associated with impaired cognitive function.
#MedTwitter #neurotwitter #dementia
2. In a recent study, effects of physical activity and regular exercise on brain infarcts, brain volume and cognition were looked at.
Reference: doi.org/10.1111/ene.15…
Reference: doi.org/10.1111/ene.15…
3. In AF patients, regular exercise was associated with a lower prevalence of ischemic infarcts and of moderate to severe white matter disease, with larger brain volume, and with better cognitive performance.
Intravenous #thrombolysis (IVT) may be safe in patients taking direct oral anticoagulants (DOACs)
1. DOACs, including apixaban, dabigatran and rivaroxaban, have emerged as the primary #stroke prevention option in patients with nonvalvular atrial fibrillation (AF).
#neurotwitter
1. DOACs, including apixaban, dabigatran and rivaroxaban, have emerged as the primary #stroke prevention option in patients with nonvalvular atrial fibrillation (AF).
#neurotwitter
2. Every sixth patient with stroke otherwise qualifying for intravenous thrombolysis has a prescription for DOACs. Guidelines recommend the exclusion of patients with recent ingestion of DOACs (within 48 hours previously) from receiving IVT should they have an ischemic stroke.
3. This recommendation to exclude patients on DOACs from receiving IVT is based on the presumption of an increased risk of symptomatic intracranial #hemorrhage (sICH), but data to support or refute this presumption are lacking.
#economy of #cigarettes: Cost, returns (if invested), impact on #Health
1. A pack of cigarettes costs Rs 330. For a month, it would cost Rs 9900 (one pack/day).
A 30-year old person has the option of smoking one pack/day or investing this amount in #mutualfunds via #SIP route.
1. A pack of cigarettes costs Rs 330. For a month, it would cost Rs 9900 (one pack/day).
A 30-year old person has the option of smoking one pack/day or investing this amount in #mutualfunds via #SIP route.
2. If Rs 10000/ is invested every month in mutual funds via SIP route (since age 30) and the expected return is 10% per annum, the savings would become a whopping 2.28 crores after 30 years (when he turns 60).
3. In addition, not smoking would reduce the risk of #heartattack, #stroke and several #cancers.
Medical insurance premium would also be lower.
So, healthcare costs would be significantly lesser for a non-smoker (as compared to a smoker).
Medical insurance premium would also be lower.
So, healthcare costs would be significantly lesser for a non-smoker (as compared to a smoker).
A fascinating symptom in #neurology is #Alien Hand syndrome
If anyone has seen @StanleyKubrick ‘s great film Dr. Strangelove, you might have wondered what’s wrong with the titular character
His hand has a #mind of its own!!!
#cinema #neurotwitter #MedTwitter
If anyone has seen @StanleyKubrick ‘s great film Dr. Strangelove, you might have wondered what’s wrong with the titular character
His hand has a #mind of its own!!!
#cinema #neurotwitter #MedTwitter
Simplifying , for carrying out bimanual planned movements, we need a Supplementary Motor Cortex (SMA) (left frontal lobe). This communicates to the opposite side via the corpus callosum. Lesions in any will impair proper bimanual function and cause an “alien limb”#neuroanatomy
Frontal variant (left sma lesion) : Patient will have impulsive groping and difficulty releasing objects
Affects the dominant hand
Can be due to a #stroke, #degeneration
My patient impulsively grabs my hand (with his right hand) despite me telling him not to!
#neurotwitter
Affects the dominant hand
Can be due to a #stroke, #degeneration
My patient impulsively grabs my hand (with his right hand) despite me telling him not to!
#neurotwitter
Low Blood Pressure (BP) is also a risk factor for ischemic stroke
1. High BP is a well-known risk factor for ischemic and hemorrhagic #stroke .
In a study, low BP was also shown to increase the risk of ischemic stroke.
doi.org/10.1210%2Fjc.2…
#MedTwitter #neurotwitter
1. High BP is a well-known risk factor for ischemic and hemorrhagic #stroke .
In a study, low BP was also shown to increase the risk of ischemic stroke.
doi.org/10.1210%2Fjc.2…
#MedTwitter #neurotwitter
2. People with baseline BP<110/65 mmHg had 88% higher risk of ischemic stroke after average follow up of 6.7 years, as compared to those with BP 120-129/70-80 mmHg.
*People with BP>160/100 mmHg had 47% higher risk of ischemic stroke.
*People with BP>160/100 mmHg had 47% higher risk of ischemic stroke.
3. In another study, low pre-stroke BP was associated with higher risk of all cause death and cardiovascular death.
Patients with average SBP<120 mm Hg and at least one comorbidity (smoking, heart disease, cancer, or dementia) had the highest mortality risk.
Patients with average SBP<120 mm Hg and at least one comorbidity (smoking, heart disease, cancer, or dementia) had the highest mortality risk.
.🔝Les comparto un resumen y mi visión de este gran artículo de Nikolaus Marx y col acerca de AR GLP-1
Un artículo esencial!!
Lo fuí mezclando con algunas diapositivas y comentarios de mi última charla de #GLP-1🧵
@SAC_54 @SACcardiometab1 @clinicasac @SIAC_cardio
Un artículo esencial!!
Lo fuí mezclando con algunas diapositivas y comentarios de mi última charla de #GLP-1🧵
@SAC_54 @SACcardiometab1 @clinicasac @SIAC_cardio
✔️La cita: Circulation. 2022;146:1882–1894. DOI:10.1161/CIRCULATIONAHA.122.059595
🤜Las estrategias intensivas para reducir la glucosa no lograron reducir efectivamente la morbilidad y la mortalidad cardiovasculares en pacientes con diabetes con alto riesgo cardiovascular
🤜Las estrategias intensivas para reducir la glucosa no lograron reducir efectivamente la morbilidad y la mortalidad cardiovasculares en pacientes con diabetes con alto riesgo cardiovascular
Psychosocial #Stress increases the risk of #stroke
1. A longitudinal study (2007-2021) was conducted on 27,000 people from 32 countries belonging to various continents to assess the relation of self-reported stress and risk of various types of stroke
#MedTwitter #neurotwitter
1. A longitudinal study (2007-2021) was conducted on 27,000 people from 32 countries belonging to various continents to assess the relation of self-reported stress and risk of various types of stroke
#MedTwitter #neurotwitter
2. Increased stress at home and at work (within the previous 12 months) increased the risk of stroke by 95% (1.95 times) and 170% (2.7 times) respectively, as compared to no self-reported stress. Recent stressful events increased the risk of stroke by 1.3 times.
3. This association was consistent for all stress domains, including work stress, home stress, and financial stress. The association was independent of socioeconomic status, occupation, and educational level & remained significant after adjustment for cardiovascular risk factors.
Case of a man who shaved only on right side of face
1. 70-year-old man was brought to OPD three months ago by his son, with a complaint that he had stopped shaving on left side of face for one week. He was also not using his left hand even though he had no weakness in that hand.
1. 70-year-old man was brought to OPD three months ago by his son, with a complaint that he had stopped shaving on left side of face for one week. He was also not using his left hand even though he had no weakness in that hand.
2. This abnormal "behavior" started all of a sudden.
When his family members pointed this oddity, he retorted by saying, the left side of face did not belong to him.
Even when he was presented with water or tea from left side, he would stretch his right hand to receive them.
When his family members pointed this oddity, he retorted by saying, the left side of face did not belong to him.
Even when he was presented with water or tea from left side, he would stretch his right hand to receive them.
3. Family members were taken aback by his "odd behavior" and decided to seek medical opinion.
His BP was 170/110 mmHg and blood sugar was normal.
He had no known medical illness. #MedTwitter #neurotwitter
His BP was 170/110 mmHg and blood sugar was normal.
He had no known medical illness. #MedTwitter #neurotwitter
