Aaron Berkowitz Profile picture
Feb 13, 2022 19 tweets 11 min read Read on X
Yes, @Tracey1milligan! How do I #LoveNeurology let me count the ways! 🧠❤️
A 🧵
Below is from a presentation where we each gave a pitch to students why our specialty was the best. All due respect to admired colleagues in other specialties, roasting/humor was encouraged😀
So when trying to choose a specialty, your advisor may ask you what’s your favorite organ?

You’ve heard the arguments:
- the skin is the largest organ in the body
- the heart moves and makes cool sounds
- the kidney has such fascinating biochemistry (if you're into that)
We have THE BRAIN. It makes us human, it's the stuff of philosophy, the only organ that can use itself to learn about itself, the organ that controls everything!

All those other organs are cool and stuff but ..um...sorry, they can be transplanted or replaced by machines....
Now some people say that's really limited to spend your whole life on just the brain, but we also take care of patients with diseases of the spine, the nerves, the muscles, each w/countless conditions that would take a life time to learn and have great impact to treat or study.
It still might seem specialized, but there is a neurology of everything! Entire books on neurology of pregnancy, of cancer, of critical illness. We still think about other organs and see patients of all ages in the clinic, emergency room, ward, and ICU.

Neurology is everywhere!
Your advisor might say will if you’re not sure pick what will give you flexibility later. We have it all!
If you like high adrenaline medicine choose neurocritical care or stroke. If you prefer clinic or lab choose cognitive neurology…and so much in between!
Is neurology too depressing? We often hear this one.

First, it’s depressing when people get sick–that’s not unique to neurology!

Second, not all care is meds/surgery. We can provide so much to patients and their families with a diagnosis and support.

And third...
During–and since–my residency I’ve seen not just countless new treatments emerge for stroke, epilepsy, MS, Parkinson, migraine…but entirely new DISEASES! Tell me another field that has not just had an explosion of new treatments but new DIAGNOSES!? #lifelonglearning #futureisnow
An advisor once told me this...Choose the field in which the chief concerns sound the most interesting...

Sorry, other specialities but...
...how's this for a chief concern? A man who mistook his wife for a hat!?

all due respect for shortness of breath, rash, and knee pain, but, um, did anyone write a best-selling book about those?
You think @OliverSacks looks like just a neuro nerd? My friends, reads his autobiography: he was a motorcyclist and could bench press 300 lbs.

Neurologists rock!
Neurology is not just the stuff of literature but also of movies:

Sorry if I missed it, but I don't think I've seen any award winning movies on GI bleeding, nephrotic syndrome, or pemphigus?
And if you're thinking, it’s not the organ or the chief concern or whatever, I'll go where I'm most needed, well look at this...
Rising burden of disease, huge neurologist shortage in the US and globally.

We need you!!! In neurology you can have an enormous impact in your local community and throughout the world!
OK, you're almost convinced but...wait neurology seemed so complicated in the 1st/2nd year of med school...

Maybe you have neurophobia?
It's not so complicated! I got you, check out these tweetorials for all of your neuroanatomy studying needs:
twitter.com/i/events/12671…

#EndNeurophobia
I dropped out of med school for 6 years, almost quit internship & never thought I'd find a specialty I'd like, let alone love. I'm 8 years out of residency and I LOVE neurology–our patients are inspiring, neurology is fascinating, and I learn something new every single day!

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More from @AaronLBerkowitz

Jun 8, 2023
Celebrating the life & legacy of Marty Samuels! Here's a master class in the neurologic examination filled w pearls, techniques, wisdom, & history for everyone from students to senior neurologists!
@rabihmgeha @DxRxEdu @AvrahamCooperMD @a_charidimou @caseyalbin @NMatch2024
Marty Samuels: Cardiovascular exam including dynamic palpation of the pulses to assess for carotid stenosis at the bedside. I remember seeing Marty do this at the bedside and being blown away!

Marty Samuels: Mental status exam

Read 8 tweets
Jun 7, 2023
Today we lost a giant in neurology, medicine,& medical education: Marty Samuels–extraordinary clinician, teacher, mentor,& leader, serving in each of these roles w/humility, humanity,& humor, training& inspiring generations of neurologists. I'm so grateful to have been among them Image
Fortunately for those who didn't have the privilege to learn directly from him, he left behind a wealth of educational resources conveying his extraordinary clinical wisdom spanning neurology, medicine, pathology, and the history of neurology, medicine, and @BrighamWomens
For example, this grand rounds, in which he teaches us to learn from our mistakes
med.stanford.edu/neurology/educ…
Read 10 tweets
Mar 26, 2023
🧠Neurology Tweetorial🧠I'm often asked about localization/diagnosis in the challenging clinical presentation MULTIPLE CRANIAL NEUROPATHIES. Here is my approach, what is yours #MedTwitter #neurotwitter @NMatch2023 @rabihmgeha @DxRxEdu @caseyalbin @AvrahamCooperMD @a_charidimou?
Multiple CNs can be caused by a STRUCTURAL lesion in
👉🏼Brainstem
👉🏼Subarachnoid space/meninges
👉🏼Skull base
👉🏼Face
👉🏼Neck

🚨 Non-Structural mimics🚨
⚡️PNS (Guillain Barre)
⚡️Motor neuron dz (bulbar ALS)
⚡️NMJ (botulism, myasthenia)
⚡️Myopathy (oculopharyngeal musc dystrophy)
How to localize? #1
👉🏼Know levels of CN nuclei in brainstem

🐭Midbrain: 3, 4
🧠Pons: 6 and 7 (medial); 5 and 8 (lateral)
🧠Medulla: 5 (pain/temp) 8 9 10 (lateral), 12 medial

See diagram:
Read 15 tweets
Oct 26, 2022
First, you might want to review this tweetorial on HORIZONTAL DIPLOPIA
Overall localization of VERTICAL similar to horizontal diplopia = Ocular misalignment due to lesion of:
-Cranial nerve/nucleus
-NMJ (myasthenia)
-Extraocular muscle/Orbit
For vertical misalignment we must also add skew, caused by a lesion in the vestibular pathways
Read 19 tweets
Jul 28, 2022
It's here! After many years of working on this 2nd edition, it's amazing to finally see and hold it!
I learned so much revising and updating this book, a 🧵
#MedEd #MedTwitter #neurotwitter #NeuroTwitterNetwork @NMatch2023 @caseyalbin @DxRxEdu
One of the most fun things to write was the preface, reflecting on how much has changed and evolved in #neurology in just a few years since the 1st edition. More on why I love neurology here:
For example the antiseizure medication table has expanded from 1 page to two...
Read 10 tweets
Jul 12, 2022
#MedTwitter #MedStudentTwitter #NeuroTwitter! This morning on @CPSolvers #VMR we discussed an approach to peripheral polyneuropathy so here’s a #tweetorial to add to the #EndNeurophobia series

Link to whole series here:
twitter.com/i/events/12671…
@rabihmgeha @DxRxEdu @caseyalbin
Peripheral neuropathy can be classified as:

Mononeuropathy: single nerve affected

Polyneuropathy: nerves affected throughout body symmetrically

Mononeuropathy multiplex: multiple individual nerves affected, asymmetric

Check out @DxRxEdu video!
clinicalproblemsolving.com/peripheral-neu… Image
MonoN and polyN are most common.

Mononeuropathy multiplex=rare

MonoN most commonly compressive or traumatic (ulnar neurop @ elbow, median neurop @ wrist, peroneal neurop @ fibular head)

Rarely: tumor (neurofibroma), infiltration (amyloid, neurolymphomatosis
Read 25 tweets

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