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Jun 30 • 5 tweets • 3 min read
Bilateral locomotor brachialis in a middle aged patient with severe hypertension and severe dizziness under eval ? post circulation stroke --> 280/170 mmg Hg (manually measured 4 times by 4 different people)

HTN is a killer!

#MedTwitter
#clinics
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@nihardesai7 @AndreMansoor @rabihmgeha @Shubhra_011 @dr_veeprakash @JaySavla15

#hypertension
#NeuroTwitter
A close up view!
@grepmeded

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More from @AdiG1993

Dr Aditya Ganguly Profile picture
Jul 3
1) Gen med residents are taught to think of secondary hypertension, especially primary hyperaldosteronism, if the following conditions are met.

- young onset HTN (age < 40)
- family history
- resistant HTN
- hypokalemia
2) First of all, young onset HTN is a controversial term nowadays --> with the rise of fast food and sedentary lifestyles with pediatric obesity and metabolic syndrome --> it is entirely possible that the age may need to be shifted even lower!
3) This study, done in AIIMS with @DrSarahAlam as the lead author looked at PA epidemiologically.

202 patients with young onset HTN (YH) were evaluated.

Surprisingly the mean age was 43.9+/- 10.9 years!
pubmed.ncbi.nlm.nih.gov/33393127/
Read 12 tweets
Dr Aditya Ganguly Profile picture
Jul 2
1) Another case of the silent killer.

A middle aged relative of mine has been forgetting things recently --> he doesn't remember where he put his keys, his assistant's name or what he had for lunch that day.
2) His daughter calls me up and schedules a meeting.

Its borderline Alzheimers --> she worries!

What will happen to him? Is there anything to be afraid of? Should we consult a neurologist?
3) First things first --> I say.

Let me evaluate him and see what needs to be done.

Turns out he is HTNsive on meds for more than a decade, since the time he had his first stroke --> no documents available from that time.
Read 8 tweets
Dr Aditya Ganguly Profile picture
Jun 19
1) Have you ever seen a case of rabies?

I saw two cases 5 years back and they have stayed with me since.

I do not fear any disease per se but I am not ashamed to say that I dread rabies --> it is a terrible affliction.
2) The first patient was a small child of around 7 years old --> he had been bitten by a street dog around 1 month back. But his family had opted for natural healers.

When he was brought in, he was crying uncontrollably with a terror stricken expression on his face.
3) Hydrophobia, as commonly believed, is not so common in these cases. Why you ask?

Its because these patients are so extremely agitated and combative, its very difficult to get close to them, let alone make them drink water.
Read 16 tweets
Dr Aditya Ganguly Profile picture
Jun 18
1) As an intern, GP or a gen med resident, you are constantly exposed to MR imaging of the brain. This is a complicated imaging modality that requires a radiologist for optimum analysis and reporting. But you must know the basic sequences and how to identify them.
2) The five most common sequence that we use in internal medicine are the T1 (with or without contrast), T2, FLAIR, DWI and ADC sequences. SWI/GRE sequences are also used in certain cases.
3) First check whether the soft tissue of the scalp and the skull (black) are visible or not --> if yes, you are dealing with T1,T2 or FLAIR.
Read 10 tweets
Dr Aditya Ganguly Profile picture
Jun 17
1) Bell's palsy (BP) is typically defined as an IDIOPATHIC unilateral LMN type CN7 palsy.

It is named after the Scottish neurophysiologist, Charles Bell. (vide infra)
2) But an LMN type CN 7 palsy is NOT the same as Bell's palsy.

It is merely the idiopathic form, often thought to be due to herpes or varicella induced direct nerve damage or as post infectious demyelination.
3) There are certain RED FLAGS in the diagnosis of an LMN type CN 7 palsy.

1. Vesicles on the tympanic membrane or ear canal (Ramsay Hunt syndrome type 2)

2. Bilateral involvement - Lyme disease, sarcoid, GBS, Melkersson-Rosenthal syndrome, Mobius syndrome etc!
Read 12 tweets
Dr Aditya Ganguly Profile picture
Jun 10
1) I was recently contacted by a young man who was unsure of pursuing NEET since he had a tumor during his preparatory phase which had badly derailed his studies.

He was worried that he had lost 'a lot of time' and that his peers were far ahead of him!
2) I told him something I had learnt from one of my mentors long back --> No plan in life, as in war, survives first contact with the enemy!
3) This is his life and his glory or his failure will be his alone --> he has faced what others (including myself) could not have dreamt of --> in my opinion, he is a warrior!
Read 4 tweets

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