Thread by @a_charidimou

🚨 🧵 Some pearls on cases I have seen last week during night call @bmcneurology @The_BMC 🧠
PRES, RCVS, Trigeminal autonomic cephalalgia, vertigo, IIH, hyperglycemic hyperosmolar syndrome, hyperK, SAH, a tone of CODES STROKE, a tone of seizures
#NeuroTwitter #MedEd #Neurology

1/
PRES 🗜️
⚡️huge spectrum
⚡️high index of suspicion in ptns with risk factors (often with HTN urgency, immunosuppression, sepsis) + seizures
🕵🏻‍♂️may not be posterior, may not be reversible, may not present as a syndrome!!
emcrit.org/ibcc/pres/ @PulmCrit

2/
⚡️RCVS
-observe (MRI, CTA), remove triggers, be cautious not to miss a dissection @interneurona
-pain control, this is the worst imaginable pain: Mg IV, opioids
-CaCB may help with headache - no proved benefit for vasoconstriction
@AneeshSinghalMD @CajalButterfly
@UpToDate

3/
Trigeminal autonomic cephalalgia – Hemicrania continua
😢unilateral head pain with ipsilateral cranial autonomic features
-merits imaging: brain MRI w/wo contrast, CTA, CTV based on context
-might respond well to indomethacin
n.neurology.org/content/74/11/…
@neuro @Manjit_Matharu

4/
😵💫🌀😵‍💫Acute onset vertigo
Vertigo-we hate it, because we are bad at it!
😵‍💫Hx is key
😵‍💫HINTS is gold if used when indicated
😵‍💫Most instructive dissection of vertigo, HINTS, myths, use and misuse by @PeterJohns84
youtube.com/user/peterjohn…

5/
IIH
-Diamox 1st line
-Topamax 25mg, ⬆️ 25mg/w for max 100mg daily 2nd line
-IV Lasix in ED
-Recent evidence for cognitive impairment

@braincomms
bit.ly/3rMSUDb @O_Grech
@ArmyBrainDoc
@IIHDrBirmingham
@DrMollan
@IMSR_UoB

6/
Hyperglycemic hyperosmolar syndrome 🚑⚠️☠️
⚠️ Can present with seizures/status epilepticus
-HHS should be in DDx of acute facial hyperkinesias
-pH, ketones, HCO3 levels usually NORMAL @Rx_Ed
bit.ly/3gUKPpz

Neurologist need to know their medicine @Tracey1milligan

7/
🚨CODE STROKE
-always humbled on how easy is to confuse aphasia for confusion!

-📕The Code Stroke Handbook by @MicieliA_MD is super helpful-it does just that: prepares you for a CODE!

-Amazing practical Code Stroke 🚨how-to
emcrit.org/emcrit/acute-i… @caseyalbin @drdangayach

@BSNNP1880 @hugoapariciomd @ludyshihmd @LucasFBHorta @Capt_Ammonia @Neurology__ @NMatch2022 @Neurobolts @shivbhadola @sudha_md @NguyenThanhMD @DavidGr68804909 @ContinuumAAN @TheNewANA1 @doctorORbust @DrThomasFord @tony_breu @EricTopol @BUgeriatrics

@estmannmd @ucyneuro