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Oren Gottfried, MD

Oct 16 • 4 tweets • 2 min read

Unfortunate young male who was assulted presents to the ED alert and oriented, with a headache & nausea, and fixed & dilated right pupil. What are your next steps? #trauma #foreignbody #Neurosurgery

Any penetrating cranial injury, I suggest CTA. One can suffer a direct or indirect vascular injury.

Anyone know the name and use of this tool?

OR removal: have vasc control or endo option ready & know CTA, widen craniotomy and open dura, corticectomy if shallow injury, TXA, be ready to coagulate like crazy as foreign body tamponaded bleeding, if exit site do same, & remove in perfect trajectory it went in.

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More from @OGdukeneurosurg

Oren Gottfried, MD

@OGdukeneurosurg

Oct 18

26 year old male in ED says, “I’ve done something very bad.” On exam, you find 5 of these on each size of his head. Thoughts? #neurosurgery #trauma

Before you can get any history, exam, or any imaging, he tries to leave AMA. What do you do?

After convincing him to stay, X-ray shows…

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Oren Gottfried, MD

@OGdukeneurosurg

Oct 15

Young man had a fall from construction scaffold and presented with a twisted steel bar in his head. Thoughts and Plans? #neurosurgery #trauma #neurotwitter

Neuro exam was normal except for a fixed and dilated left pupil. Credit: Luo and Fei.

CTA - good news… no vascular injuries. Doctor, do you want any other specialties in the OR with you?

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Oren Gottfried, MD

@OGdukeneurosurg

Sep 26

50 yo female with progressive eye redness and loss of visual acuity. She has a h/o hypertension. Thoughts? #MedEd
#MedTwitter #health #healthcare #FOAMed #ClinicalPearl #clinicaltips #neuroscience #neurotwitter
#sciencetwitter #brain #medstudenttwitter #medical

Neuro intact other than vision.

What is reason for redness, specifically?

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Oren Gottfried, MD

@OGdukeneurosurg

Sep 24

What in the world is going on here on this awake #patient ?

Hint: it is not a c1-2 puncture, which is used when lumbar puncture is not an option.

Occipital puncture into 4th ventricle in awake patient.

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Oren Gottfried, MD

@OGdukeneurosurg

Sep 24

This… is why I became a #neurosurgeon and what rehabilitative specialties love to do.

Source: ESPN. The key of spine surgery and rehabilitative efforts is collaborating with our patients to achieve functional independence in the presence and in the absence of any neurological recovery.

I look forward to further advances and applications of brain computer interface, spinal cord stimulation, neural prosthesis, exoskeletons, nerve transfers, and things we don’t know of yet… for assisting patients with spinal cord injuries.

Read 4 tweets