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Hikmatullah Khan,FCPS Neurology Profile picture
Sep 15, 2020 12 tweets 4 min read Read on X
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.
4) Sensory::
Paresthesia of face & hand, may spread to lower limbs & trunk.
Language::
Word finding difficulty, Dysphasia.
Brainstem Aura::
Dizziness, vertigo, dysarthria, diplopia, tinnitus, hyperaccusis, ataxia, decreased Level of Consciousness.
5) AURA can occur without headaches, headaches with aura have Increased Pain severity, and less duration. Headaches without aura have less severe headaches and increased duration of headaches.
6) MECHANISM BEHIND AURA::
VASCULAR CHANGES::
Brain Hypoperfusion in distribution correlated with aura symptoms.
7) CORTICAL SPREADING DEPRESSION::
Slowly propagated depolarization followed by suppression of electro graphic activity, associated with massive release of neurotransmitters and either vasodilation or vasoconstriction. Also observed in TBI, Ischemic and Hemorrhagic strokes.
8) AURA Associations and Significance::
Sex Hormones... Especially Estrogen Based.
PFO... with aura and Stroke.
Stroke... Migraine with aura & stroke
Psychiatric..Depression, Panic, Bipolar, suicidality
9) Misconceptions::
1:Avoiding Triptans in migraine with AURA due to possible vasoconstrictive effects of drug, But MRA shows that Drug don't constrict Vessels.
10) 2:Avoiding Estrogen based Contraceptive pills, that it will increase migraine with aura, secondary increasing stroke risk with migraine with aura, All studies agree to that absolute risk is small and low dose estrogen can be used.
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More from @DrSherani432

Sep 15, 2020
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
Aug 25, 2020
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
Aug 21, 2020
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
Aug 16, 2020
1) MYOTONIA
Pure stiffness : Chloride channelopathy
Pure periodic weakness : Calcium + Potassium Channalenopathy
Overlapping Syndrome: (Myotonia, Paramyotonia, HyperKK, HypoKK) Sodium Channelopathy
A=CHLORIDE CHANNEL (Myotonia congenita)
Chloride channelopathy(CLCN1) ,Family
2) Hx, Two forms, face + limbs(distal muscles)
AD#Thomson early onset, Less severe, muscle hypertrophy.
AR#Beckor.. Late onset, more severe, shows warm up phenomenon.
Dx:
CMAP amplitude decrement short post-exercise which rapidly returns to baseline. Decrement that repairs
3) with repeated trials. Cooling no affect.
Rx:
Mexelitine,Tegral, Phenytoin, Procainamide.
All muscle membrane stabilizers by blocking Sodium Channels.

B=Na CHANNEL (paramyotonia congenita)
Proximal + distal limbs muscles, face, neck.
Worse with cold + exercise
SCN4A
Read 17 tweets
Aug 11, 2020
(1/4) Collagen VI CMD
Gene's..... COL6A1, COL6A2, COL6A3.
Progressive contractures, rigid spine, distal joint laxity, respiratory function decline,keloid scar, normal-moderate CK elevation.
(2/4) 1:Ulrich severe Type
AR, At birth, decrease fetal movements, kyphoscoliosis, distal joints hyper-laxity, contracture of proximal joints(hip joints), hyperkeratosis pilaris on the extensor surface of hands. Loose ambulation at 10 yrs
(3/4) 2:Intermediate
With time Ulrich develope other symptoms like Respiratory involvement, Rigid Spine,Distal hands contractures.loose ambulation at 19 yrs.
Read 5 tweets
Aug 8, 2020
(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

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