Rafid Mustafa Profile picture
Mar 3, 2022 13 tweets 6 min read Read on X
1/
Inspired by phenomenal #neurotwitter educators @caseyalbin, @zach_london, @LyellJ.. I figured it's finally time to join the #tweetorial game.

Let's begin with a case:

A patient presents to your clinic with new paraparesis and this imaging finding.

What do you do do next?
2/
▶️IV corticosteroids?
▶️IVIG?
▶️Plasma Exchange?
▶️...?
3/
Here's the thing-
Misdiagnosis of myelopathies is common
Many patients, especially those with hyperacute or progressive myelopathies, are incorrectly labeled as having "transverse myelitis" which can lead to iatrogenic morbidity from inappropriate investigations or treatments.
4/
In 2018, @nzalewski2 published this piece in @GreenJournal showing the majority of patients referred to Mayo Clinic with suspected "idiopathic transverse myelitis" ultimately had an alternate specific diagnosis (over 1/3 of which were nonfinflammatory!)
n.neurology.org/content/90/2/e…
5/
Our colleagues @HopkinsMedicine (Drs. Barreras Cortes, Pardo-Villamizar, and team) published similar findings in @GreenJournal that same year, highlighting the importance of clinical history, imaging, and CSF characteristics in myelopathy diagnosis.
n.neurology.org/content/90/1/e…
6/
So where does that leave us in how we approach myelopathy?
7/
Huge credit to my mentor @EoinFlanagan14 in shaping how I approach myelopathies...
I learned from him how critical the clinical history is, particularly the time from symptom onset to maximal neurologic deficit.
We can break this time to nadir into three categories:
8/
▶️Hyperacute (<12 hours)
▶️Acute/subacute (1-21 days)
▶️Chronic/progressive (progression beyond 21 days)

This approach helps us narrow our differential
9/
Hyperacute

Think vascular (e.g., spinal cord infarction).
10/
Acute/subacute

Think inflammatory or infectious.
11/
Chronic/progressive

Think alternative causes like spondylosis, dural arteriovenous fistula, sarcoidosis, nutritional, or neoplastic.
12/
Back to our case...

What do we do next?
What is the alternate, specific diagnosis?
13/
Well if you're interested, join me over the coming weeks to see how we can use concepts we learned today as well as some fun signs (see below) to narrow down a number of myelopathy diagnoses...

Thanks all!
Extremely excited to more officially join the #MedTwitter community!

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More from @RafidMustafa

Aug 30, 2022
1/
A 40-year-old woman presents with acute onset vision and sensory changes.

Neurologic exam is notable for multifocal homonymous visual fields cuts, subtle left hemisensory neglect, and cognitive impairment beyond expected in such a young patient.

Her MRI Brain is below. Image
2/

Her fasting lipid panel, fasting glucose, intra and extracranial vessel imaging, and echocardiogram are largely unremarkable.

What should we do next?...
3/

Looking closely at the MRI, we notice a few key points:
Read 21 tweets
Aug 23, 2022
#neurotwitter

Over the last few weeks we've completed our Summer Lecture Series @mayoneurores. See below for some highlights...

@jenm_t @EYemmCoon
2/

Dr. @ChiaChunChiang gave us a whirlwind tour of headache disorders, including strategies Dr. @daviddodick previously outlined to screen for sinister secondary headache syndromes... Image
3/

As well as simple approaches to common primary headache disorders like migraine Image
Read 17 tweets
Mar 17, 2022
1/
Hello #NeuroTwitter

Ready for our next case?

A 40 year old woman presents with back pain and unsteady gait.
One week ago, she had a mild viral URI.
Over the coming days, she developed progressive lower extremity weakness and urinary retention.
2/
Neurologic exam:
▶️Flaccid paraparesis
▶️Numbness from the knees down
▶️Flexor plantar responses

MRI below: Image
3/
What do we do next?
Read 18 tweets

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