Discover and read the best of Twitter Threads about #tweetorials

Most recents (24)

1) Welcome to a 🆕accredited tweetorial from @cardiomet_CE! We welcome back expert faculty @ChristosArgyrop to discuss screening for #CKD in pts w/ #T2D & the role of routine assessment for #microalbuminuria as an effective diagnostic, risk stratification, & patient ed tool.
2) Christos Argyropoulos MD, PhD @ChristosArgyrop is Division Chief, Nephrology @UNMHSC. #CKD is chronic #kidneydisease, #ESKD is end-stage kidney disease.
#FOAMed #nephtwitter #cardiotwitter @MedTweetorials @NephUCommunity @ISNkidneycare @KidneyDiseaseFm Image
3) This program is intended for #HCPs and is supported by an unrestricted educational grant from Bayer. Statement of accreditation & faculty disclosures at cardiometabolic-ce.com/disclosures/.
FOLLOW US for more expert-authored #tweetorials and earn #MedEd
Read 43 tweets
2/
Classically placed in the arm
May be placed in the leg (eg in #pediatrics /neonates – which may then terminate in the infrarenal IVC/iliacs)
.
#criticalcare #cardiovascular
3/
Advantages:
- Lower infection rate then central lines
- Used in the outpatient setting
- Can be used for several weeks to months
- Duration of PICC lines may be from 4 weeks to 6 months
(although they have been known to be functional for more than 300 days)
Read 20 tweets
Tony @tony_breu holding court on renal physiology in ATN at #ApExPathshala
Is TGF in ischemic ATN good or bad? Image
The seminal paper of course is Klaus Thurau on Acute Renal Success
#ApExPathshala pubmed.ncbi.nlm.nih.gov/961698/ ImageImage
Without TGF, we would not have Acute Renal Success, we would have ‘complete renal failure’
@tony_breu At #ApExPathshala Image
Read 6 tweets
1) Welcome to this #accredited #tweetorial on genetic testing in the evaluation of patients with cystic kidney disease. #Kidney #cysts are a frequent finding, ranging from simple cysts to suspected or confirmed #ADPKD.
Expert author @dguerrot of @CHURouen 🇫🇷 leads us!
2) This program is supported by an educational grant from Otsuka Pharmaceuticals & is intended for #HCPs. #Physicians #Physicianassociates #nurses #nursepractioners #pharmacists 🇺🇸🇨🇦🇪🇺🇬🇧 earn CE/#CME credit. Statement of accreditation & faculty disclosures ckd-ce.com/disclosures
3a) Fortuitous discovery of non-malignant kidney cysts is increasingly frequent with age, and often leads to #nephrology referral.
Read 52 tweets
Diencephalon location
- around the 3rd ventricle

The cavity of the diencephalon is ----- the 3rd ventricle
All of the structures of the diencephalon are around the 3rd ventricle, so the cavity of the diencephalon is the 3rd ventricle.

2/
Diencephalon embryology

- prosencephalon

3/ Image
Read 36 tweets
The Examination in Coma

“the father of modern neurological surgery”

American neurosurgeon Harvey Williams Cushing (1869–1939)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/ Image
Definition

“a state of unarousable unresponsiveness”

Parts
a. level of consciousness
b. vital signs (BP & breathing pattern)
c. cranial nerves (fundoscopy + vision + brainstem)
d. motor & sensory
e. reflex
f. meningeal signs

2/
Level of consciousness

Normal
Clouding of consciousness
Confusion/delirium
Lethargy
Obtundation
Stupor
Coma

3/ Image
Read 30 tweets
Drifts!!!

French neurologist Jean Alexandre Barré (1880–1967)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
The four types of drift

“pronator, cerebellar, parietal, and functional”

- pronator drift (pyramidal drift) was the 1st to be described
- Dr. Barre was the 1st to report it

2/
Pronator drift (Barre’s sign)

progress from distal to proximal

1st downward arm drift
2nd forearm pronation
3rd flexion of the wrist and elbow

3/
Read 18 tweets
Brachial plexus!!!

“Erb-Duchenne palsy, Erb-Charcot paralysis, Erb's point, Erb-Westphal symptom, Erb's spot”

German neurologist Wilhelm Heinrich Erb (1840–1921)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
Components

“Ready To Drink Cold Beer”

Root (5): C5-T1
Trunk (3): upper, middle, lower
Division (6): anterior & posterior from each of the trunks
Cord (3): lateral, posterior, medial
Branch (5)

2/
How are roots formed?

“formed by the anterior (ventral) rami of C5 to T1 spinal nerves”

Extent
- interscalene triangle (bounded by anterior scalene and middle scalene)

3/
Read 24 tweets
Signs of tetany!!!

“Trousseau sign of malignancy, Trousseau sign of latent tetany, Trousseau–Lallemand bodie”

French internist Armand Trousseau (1801–1867)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
Definition

Tetanus
- it is different disease w/ different pathology

Tetanic contractions (physiologic tetanus)
- broad range of muscle contraction types

Tetany
- a type of tetanic contraction

2/
Clinical manifestations of tetany

“spasm and tonic contractions of the skeletal muscles, principally the distal muscles of the extremities”

3/
Read 25 tweets
Meningeal signs

“Brudziński neck sign, Brudziński symphyseal sign, Brudziński cheek sign, Brudzinski's reflex”

Polish pediatrician Józef Polikarp Brudziński (1874–1917)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
Definitions

Meningitis
-inflammation of leptomeninges & underlying subarachnoid CSF

Meningismus
-morbid state characterized by meningitic syndrome (triad: headache, photophobia, nuchal rigidity)

Meningism
-synonymous of meningismus
-neck stiffness w/o meningeal inflammation
2/
Mechanism

“maneuvers used to elicit meningeal signs produce tension on inflamed and hypersensitive spinal nerve roots, and the resulting signs are postures, protective muscle contractions, or other movements that minimize the stretch and distortion of the meninges and roots”

3/
Read 27 tweets
Autonomous Sensory Zones
(peripheral nerves)

Median nerve illustration by Guttmann (1939)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
Definition

“regions where single nerve roots supply distinct and non-overlapping areas of skin”

- small portion of dermatome
- few nerve roots have such autonomous zones
- great variability

2/
Sensory zones

a.maximal zone: maximal area supplied by a peripheral nerve
- maximal=intermediate+autonomous

b.intermediate zone: area of overlap of the maximal zone of different peripheral nerves

c.autonomous zone: area exclusively supplied by a particular peripheral nerve
3/
Read 14 tweets
Inverted & Perverted Reflexes

The first description of the paradoxical (inverted) triceps reflex

French neurologist Alexandre-Achille Souques (1860–1944)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/ Image
Definition

“elicitation of the movement opposite to that normally seen when the reflex is elicited”

2/
Mechanism

“a lesions simultaneously affecting the roots and spinal cord”

Damaged root
- interrupt local reflex
- absence of contraction

Damaged spinal cord
- interrupt corticospinal tract
- hyperactive response of the lower spinal segment

3/
Read 15 tweets
Myotonic disorders!

“after a fright, or in an unexpected joyous movement, this convulsive constriction occurs in all limbs…the victim can not stand upright”

Prussian physician Asmus Julius Thomas Thomsen (1815–1896)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/ Image
Definition

“difficulty in relaxation of a muscle after maximum voluntary contraction”

It can be specifically
- aggravated by conditions
- affecting regions of the body
- triggered

2/ Image
Myotonic or Tennessee fainting goat

“important in history due to role of chloride channel in muscle excitation”

- 1880s, Marshall County
- CLCN1 gene

via: jimmywan87

3/
Read 28 tweets
Dermatome!!!

“Dermatomal man, early twentieth century”

University of Edinburgh Image Collections

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
History

“dermatomal charts are primarily derived from 3 sources”

Head & Campbell
-herpetic eruptions

Foerster
-rhizotomy in chronic pain
-dermatomal overlap

Keegan & Garrett
-various diseases
-exam & surgical correlate: 53%

American neurosurgeon John Jay Keegan(1889-1978)
2/
Definition

“area of skin in which sensory nerve derive from a single spinal nerve root”

- 31 spine segments
8C + 12T + 5L + 5S + 1 coccygeal
- dermatomes exist for each spinal nerve, except C1

3/
Read 25 tweets
Hereditary Ataxias!!!
Spinocerebellar ataxias (SCA)

“SCA1 …. the unstable CAG trinucleotide repeat expansion”

American geneticist Harry T. Orr

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
SCA definition

“complex group of heterogeneous degenerative diseases of the cerebellum and its connections”

2/
Worldwide distribution of SCA subtypes

21% SCA3, Brazil & Portugal
15% SCA2, India & Singapore
15% SCA6, Japan & Germany
6% SCA1, South Africa
5% SCA7, South Africa
3% SCA8, worldwide

<1% rare
SCA 10, SCA 12, SCA 14, SCA17

3/
Read 18 tweets
Dancing larynx!!!

“a variant of palatal tremor?”

British neurologist Anette-Eleonore Schrag
1999, first description
@UCLIoN

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/ Image
Definition

“rhythmic vertical laryngeal cage movements of varying frequency with synchronous movements of the tongue, posterior pharynx, and the palatopharyngeal arch”

- not affecting uvula

2/ Image
Pathophysiology

Variant of palatal tremor
- oscillatory firing of neurons in the inferior olives

Functional

3/
Read 7 tweets
Rabbit syndrome!!!

“a peculiar extrapyramidal reaction”

Canadian psychiatrist André Villeneuve
1972, the first report

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
Definition

“stereotyped vertical, rhythmic movements, similar to the chewing movements of a rabbit”

5 Hz
Lips produce a popping sound
Not tardive dyskinesia!
- persist stage I sleep

2/
Pathophysiology

- cholinergic system?

3/
Read 15 tweets
Belly Dancer's Dyskinesia!!!

“first described by Antonie van Leeuwenhoek in 1723 when he himself experienced the symptoms”

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
Definition

“rhythmic, involuntary contractions of the diaphragm resulting in undulating, rhythmic movements of the abdomen resembling a belly dance”

-bilateral, most freq
-limited to axial musculature
-sometimes painful
-no suppress on breath holding
-150 contraction/min

2/
History

1723, Leeuwenhoek
- 1st report
- diaphragmatic flutter

1976, Nichols
- 1st report
- abdominal wall dyskinesia
- phrenic palsy in a newborn

1990, Iliceto
≠ diaphragmatic flutter

3/
Read 26 tweets
Jack-in-the-box tongue!!!

“The English Hippocrates”

English physician Thomas Sydenham (1624 – 1689)
discovered Sydenham's chorea

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
Pathophysiology

“combination of chorea & motor impersistence”



2/
Definition

“unable to maintain tongue in protruded state and the tongue moves in and out”

3/
Read 20 tweets
Milkmaid’s grip!!!

“motor impersistence of the hand”

Philippus Aureolus Theophrastus Paracelsus Bombastus von Hohenheim (1493–1541)
(Paracelsus)
first coined the term Chorea Sancti Viti

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
Pathophysiology

“combination of chorea & motor impersistence”

Motor impersistence
- inability to maintain tetanic muscle contraction
- positioning & compensatory repositioning
- independent of chorea
- linearly progressive (marker of disease severity?)
- frontal lobe

2/
Examples of motor impersistence

- Milkmaid’s grip
- inability to maintain eye closure
- ‘Jack in the box’ tongue

3/
Read 19 tweets
I've seen two patients in my training with ring chromosome 20 associated epilepsy, which inspired my recent talk at #CleClinicNeuro Peds Epilepsy GR, so I decided to distill it to a #neurogenetics #epilepsy #tweetorial 🤓 🧬
1/🧵
what is a 💍 chromosome? Rather than having a full complement of rod-shaped chromosomes like this:

2/ 🧵
affected individuals have at least one chromosome with circular formation, due to fusion of distal chromosome regions:

3/ 🧵 Kalane et al.  Int J Epil 2017; 04(01): 087-089
Read 18 tweets
Glabellar reflex (Myerson's sign)!!!

"the preliminary note on a new cranial reflex"

British doctor Walker Overend (1858–1926)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/ Image
Glossary

Glabellar reflex
Habituation
Myerson’s sign
Primitive reflex

2/ Image
History

1896, Dr. Walker Overend
- first report

1901, Dr. Daniel J. McCarthy
- published a 2nd report without acknowledging Overend

1944, Dr. Abraham Myerson
- observed, mainly, in PD

1954, Dr. Doshay
- called Myerson’s sign

3/ Image
Read 16 tweets
Wing-beating tremor!!!

“pseudosclerotic, parkinsonism, and dystonic/choreic forms of Wilson’s disease”

American-born British neurologist Samuel Alexander Kinnier Wilson (1878–1937)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
Pathophysiology

“lesion in the dentatorubrothalamic pathway”

- cerebellar outflow pathway

Complex phenomenology
- dystonic, myoclonic, rhythmic tremor?


2/
Definition

“low-frequency, high-amplitude, posture-induced proximal arm tremor, elicited by sustained abduction of the arms, with flexed elbows and palms facing downward”

- postural tremor
- wing-beating posture

3/
Read 21 tweets
Nystagmus series – Part VII
(seesaw & hemi-seesaw nystagmus)

“Maddox rod, double prism Maddox, red glass Maddox, Maddox cross, and Maddox wing”

British ophthalmologist Ernest Edmund Maddox (1863–1933)
(first report)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/ Image
Definition

“one half-cycle of elevation&intorsion of one eye
and
synchronous depression&extorsion of the other eye.
Next half-cycle,
vertical&torsional components are reversed”

- waveform: pendular (seesaw) & jerk (hemi-seesaw)
- hemi-seesaw: only one half-cycle

2/ Image
Pathophysiology

Jerk (hemi-seesaw)
- lesion in the interstitial nucleus of Cajal

Pendular (seesaw)
- parasellar (midbrain compression & visual field defects)
- calibration lesion

3/ Image
Read 23 tweets

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