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Oct 18 13 tweets 4 min read
Lumbar puncture 101: a brief overview
👀🦅

#NeuroTwitter #Neurology #LumbarPuncture

1/🧵
Before we begin, it is important to address that every case is different and for every procedure pros and cons must be discussed along with the patient and his/her relatives as no medical procedure is exempt of complications. 🚨🚨

2/🧵
What is a lumbar puncture?
A lumbar puncture (LP) is an invasive technique that accesses the restricted compartment of the subarachnoid space in order to sample CSF.
💉💉🏥🏥

3/🧵
How is it performed?
Two positions
1.- Left lateral recumbent position
2.- Sitting position: this one is not suitable for measuring pressure.

4/🧵
Tips:
1⃣Lay the patient with the head on the same side as your dominant hand.
2⃣L3/L4 space is usually the easiest to access
3⃣Remember, spinal cord ends between L1/L2 in adults
4⃣Difficult cases may require to use the seated position

5/🧵
Most frequent indications 👨‍⚕️👨‍⚕️👨‍⚕️🩺
1⃣Confirm or rule out CNS infections
2⃣Study CSF looking for inflammatory disorders (MS, NMDA, etc)
3⃣Therapeutic/diagnostic (IHH, NPH)
4⃣Test for biomarkers of many neurological disorders
5⃣Drug delivery

6/🧵
Common contraindications 🚫
1⃣ Low platelet count* or INR >1.5
2⃣Local skin infection
3⃣Local developmental abnormality, e.g. myelomeningocele
4⃣Suspected Raised intracranial pressure + herniation predictors on CT/MRI

7/🧵
CT scan before lumbar puncture?
Older patients (>60 y/o) 🧓
Immunocompromised state 🛡️
History of CNS disease 🧠
Any neurological findings on the exam 🧪

8/🧵
What do we measure?
1⃣ Pressure
2⃣ Glucose (always measure finger prick glucose to obtain CSF-to-Blood ratio)
3⃣ Protein level
4⃣ # of cells and predominant cell type
5⃣Extra tests according to every case (OCB, NMDA, Culture, Lactate, etc).

9/🧵
Most Fx complication?
Headache 🤕🤕🤯🤯

Treatment, risk factors and preventive measures of Post-LP-Headache is topic for another thread.

10/🧵
Remember, in medicine there are no two exact same cases and no absolute rules (or truths) exist in our science.
Always individualize situations and remember "Primum non nocere".
Sources:
1.- J Neurol. 2012 Aug;259(8):1530-45.
doi: 10.1007/s00415-012-6413-x
2.- CONTINUUM (MINNEAP MINN) 2018;24(5, NEUROINFECTIOUS DISEASE):1264–1283.
doi: 10.1212/CON.0000000000000660.
3.- N Engl J Med. 2001 Dec 13;345(24):1727-33.
doi: 10.1056/NEJMoa010399.
4.- Infect Dis (Lond). 2018 Jul;50(7):514-521.
doi: 10.1080/23744235.2018.1441539

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Oct 13
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🗣️📢📚

1/🧵
Disclaimer:
Language is a very complex brain function. The following tweetorial aims to present useful tips for everyday practice, especially when dealing with language disorders. This does not substitute by any chance a formal Neuropsychological evaluation.
🚨
2/🧵
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2/🧵
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3/🧵
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#Neurotwitter #Neurology #Neuroanatomy #Endneurophobia.

1/🧵
First of all a brief disclaimer.
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2/🧵
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3/🧵
Read 30 tweets
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#Neuro #EndNeurophobia #Neurotwitter #Neuroexam

1/🧵
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2/🧵
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3/🧵
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Once again, many syndromes, one pathology. 🧠💊🏥
1/🧵
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2/🧵
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3/🧵
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1/🧵
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2/🧵
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Ti(ming) ⏲️: episodic and acute
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A (ssociated signs/symptoms/history) 🧠👀: HINTS, Dix-Hallpike, Headache, etc.
Te (st) 🩻: MRI, CT
3/🧵
Read 11 tweets

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