Beauty Parlor #Stroke Syndrome

1. I recently saw a 50-year old woman with symptoms of dizziness, nausea & vomiting, which started during her hair wash with shampoo in a beauty parlor. Initially, she was taken to a gastroenterologist, who treated her symptomatically.
#Medtwitter
2. Symptoms did not improve, the next day she developed mild imbalance while walking. She was referred for my opinion. She had mild right cerebellar signs. MRI brain revealed infarct in right posterior inferior cerebellar territory, MR angiogram showed left vertebral hypoplasia
3. A diagnosis of #beauty #parlor stroke syndrome involving right PICA territory was made. Possible mechanism is kinking of vertebral artery during hyperextension & turning of neck towards wash-basin while washing hair with shampoo. She had well controlled #Hypertension too.
4. Take home message: Stroke affecting vertebro-basilar artery territory can occur during shampoo hair-wash in a beauty parlor, especially in women with other atherosclerotic risk factors and undetected vertebral hypoplasia. Prompt recognition and treatment can prevent disability

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More from @hyderabaddoctor

Oct 30
#Stroke after the neck-crack & head massage by a barber after haircut
1. I saw a 22-year old being brought to the emergency room on a stretcher (1999 @OffCMCVellore. He had developed dizziness, followed by weakness of limbs and breathing difficulty after neck-crack by barber.
2. He was perfectly well prior to going for hair cut. Symptoms started soon after head massage and neck-crack by the barber. MRI brain showed infarcts in left cerebellar hemisphere and medulla. MR angiogram showed features of left vertebral artery dissection.
3. He was intubated & mechanically ventilated. Anticoagulation with heparin was started. He was gradually weaned off the ventilator and was discharged after 7 days with minor deficits. He made a gradual recovery after three months with warfarin and physiotherapy.
#MedTwitter
Read 4 tweets
Oct 29
Iron-deficiency anemia: 5 interesting facts

1. The richest source of iron is meat.
For vegans and vegetarians, the best source of iron is blackstrap molasses. Other good sources of iron are lentils, tofu, spinach and soybeans.

#MedTwitter #InternalMedicine #MedEd
2. What is pagophagia?
Half of patients with moderate iron-deficiency #Anemia develop pagophagia. Usually, they crave ice to suck or chew. Occasionally, patients prefer cold celery or other cold vegetables in lieu of ice.
3. Severe anemia may cause myocardial ischemia and coronary insufficiency. Patients can present with heart failure. General examination reveals koilonychia, angular stomatitis and gingivitis (fissures at the corners of mouth).
Read 5 tweets
Oct 28
Association of Muscle-Strengthening and Aerobic Physical Activity With Mortality in US Adults Aged 65 Years or Older
jamanetwork.com/journals/jaman…
#exercise #Longevity #mortality #elderly
1. As little as 10 min/wk of aerobic exercises caused lesser deaths in elderly as compared to <10 min.
2. Benefits of aerobic activity were seen up to 300 min or more per week.
3. 32% lower deaths occurred with >300 min/wk of aerobic exercises as compared to 17% in 10-150 min grp
4. For muscle strengthening activity (MSA), the effect on death rate was U shaped. Deaths were higher with <2 and >6 sessions of MSA. Lowest deaths occurred in elderly doing 2-6 sessions of MSA.
Read 4 tweets
Oct 26
How to achieve a lower heart rate (HR) while running?

HR increases while running as with any aerobic activity. Workout is more effective when HR increases. How much increase in HR is ideal? How to achieve a lower HR if it exceeds the recommended maximum HR? Sharing my experience
1/n
What is the recommended maximum HR while #running?
It is 50-70% of max HR for medium paced running and 70-85% of max HR with fast paced running.
Max HR is 220 minus age. (Ref: American Heart Association- AHA)
2/n
Are there any dangers if we exceed the recommended HR zones while running?
Lower HR generally indicates good heart health, and higher HR suggests the reverse. High HR puts extra strain on the heart and can cause heart muscle damage in the long term, leading to scar formation
Read 8 tweets
Oct 26
Reasons I love #neurology
1. 2022 is my 25th year in Neurology. I enjoy this subject many times more than 1998, when I entered this branch as a #resident at @OffCMCVellore I was dissuaded by many of my teachers to take up DM in another specialty but I stuck to Neurology
THREAD
2. Neurology is vast: If you love reading, there are several topics you can read. There are about 600 common #diseases in Neurology to read about. Newer diseases are being discovered, so there is no dearth of new topics to learn about.
3. History & physical examination are still the most important to arrive at a diagnosis. Whether it is epilepsy, migraine, stroke, Parkinson's disease or Alzheimer's disease, history & physical are more valuable than any investigations. MRI, EEG & EMG contribute but are not final
Read 11 tweets
Oct 25
Awesome October 2021: A month of 31 half #marathons on 31 consecutive days- sharing my experience
1.Starting from 30th September, and ending on 31st October 2021, I completed 32 runs of 21.1 km or longer, with a total mileage of 817 km in 32 days (average of 25.5 km/day).
This included one Full marathon (42.2 km) on 30th October.
2.The purpose was to test my #endurance, and to see the #physical & #mental effects of long distance #running on 32 consecutive days. I present my observations here.
3. How difficult was it? In reality, it was not difficult. Once you get up and start the run, it is easy to complete. The most important is- you need 2.5 to 3.5 hours time to compete the distance. I could manage that in the mornings between 5 and 8:30 AM.
Read 11 tweets

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