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Dec 23, 2022 10 tweets 4 min read Read on X
Sporadic Creutzfeldt-Jakob disease: clinical variants 🧠

🥸🤓

🐄

#CJD #Neurology #EndNeurophobia #Teaching

1/🧵

⏬One of my favorite 📚 about the topic (non medical and it focuses on familial forms)
Introduction 🚨

As seen in other types of neurodegenerative disorders (AD), the main localization of the pathological process will give rise to the main symptoms.

"It's not about pathophysiology, it's about localization." 🧠🤓🥸

2/
1⃣ Heidenhain Variant

Posterior localization, think 🤔

Visual disturbances first: 👀👁‍🗨👁️

3/
2⃣ Brownell-Oppenheimer variant

"Pure cerebellar form" (at the beginning) 🧠

Progressive subacute cerebellar deficits🤔

4/🧵
3⃣ Stern-Garcin variant

Thalamic and basal ganglia predominant involvement 🧠🕺

🤔Falls and severe parkinsonism are the main characteristics. 🧑‍🦯

5/🧵
4⃣ Amyotrophic variant?

Most controversial

Think 🤔LMN involvement is prominent 🔨

ALS like features (fasciculations, weakness, atrophy, EMG changes, etc.)🍖

6/🧵
5⃣ Classical variant🧠

"Rapidly progressive dementia syndrome" 🤔 +/-
ataxia at illness onset

7/🧵
Careful clinical exam and history may help accurate diagnosis. 🥼

Unfortunately as of today, there is no effective treatment, nevertheless, advance care planning is an invaluable tool which may help not only the patients, but the families as well. ✍️
Sources:
1.- Br J Hosp Med (Lond). 2018 Dec 2;79(12):712-713. doi: 10.12968/hmed.2018.79.12.712
2.- Eur J Neurol. 2022 Aug;29(8):2412-2419. doi: 10.1111/ene.15380
3.- Arch Neurol. 2009 Feb;66(2):208-15. doi: 10.1001/archneurol.2008.533
Sources:
4.- Neuroradiology. 2001 Sep;43(9):746-9. doi: 10.1007/s002340100587
5.- Neurohospitalist. 2021 Jul;11(3):270-271. doi: 10.1177/1941874420977604
6.- Arch Neurol. 2000 Jan;57(1):33-8. doi: 10.1001/archneur.57.1.33

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More from @MedinaRiojaMD

May 12, 2023
Atypical variants of motor neuron disease.

🧠🏥🏃

#Neurology
#Neurotwitter
#teaching
#Neuro
#MiniThread

Does the phenotype matter?

Yes, as prognosis is different in some variants.

1/🧵 Image
a) Spinal-Onset ALS
b) Progressive Muscular Atrophy
c) Progressive Bulbar Palsy/Bulbar-onset ALS
d) Facial onset sensory and motor neuronopathy (FOSMN)
e) Flail-arm syndrome (Vulpian-Bernhardt syndrome): LMN upper limbs and UMN (usually only brisk reflexes in lower limbs)
2/🧵
f) Hirayama disease: monomelic amyotrophy
g) O’Sullivan-McLeod syndrome: slowly progressive distal amyotrophy of the hands and forearms extending over long periods of time
h) Flail-leg syndrome
3/🧵
Read 5 tweets
Jan 1, 2023
Midbrain Syndromes: Parinaud, Weber, Benedikt, Claude and Nothnagel.
🧠🥸🤔

#NewYearNewThread

#Neurology #Anatomy #Neurotwitter #History

1/🧵
Before we describe the main characteristics of these syndromes, it is improtant not to forget the main structures present in this region. ⚠️

Note: this is not a neuroanatomy 🧵

2/🧵
Structures not to forget at this level:

1️⃣ Corticospinal tract: motor function (contralateral)
2️⃣ Oculomotor nucleus: CN III👀
3️⃣ 🔴 Nucleus: rubrospinal tract 🦾 (arm flexion)
4️⃣ Subst Nigra: basal ganglia relay (more complex than that)
5️⃣ Inf Colliculus

2/🧵
Read 24 tweets
Dec 26, 2022
4⃣ core brain networks (there are more): expanding the localizationist approach 🧠 🥅🕸️

#Neuro #Neuroanatomy #Neurology #EndNeurophobia

#Thread

1/🧵
1⃣ Default mode network

🥇 Endogenously mediated activities at rest
🥈 Self-referential and social cognitive processes,

🚫Not active during external goal-oriented processes

2/🧵
1⃣ Default mode network

Components

💠 Posterior cingulate cortex
💠 Medial prefrontal cortex
💠 Precuneus
💠 Inferior parietal and medial temporal cortices

3/🧵
Read 10 tweets
Dec 16, 2022
Idiopathic intracranial hypertension: MRI features.

#Neurology #Neurotwitter #MRI #educational #Tweetorial

🪡

1/🧵
1⃣ Empty sella turcica (🏹)

🚨Flattened appearance of the pituitary gland against the floor of the sella turcica (🔼)

2/🧵
2⃣ Enlarged Meckel caves bilaterally, filled with CSF (🏹)

Related to Temporal Lobe Epilepsy? Maybe

3/🧵
Read 9 tweets
Dec 12, 2022
Dementia with Lewy Bodies:

Part 2️⃣ Biomarkers
🧠💊⚕️

#Neuro #Neurotwitter #Teaching #Education

#NotEverythingIsMemory

#Dementia

1/🧵
Introduction

What is a biomarker? 🏷🧪️

"A characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention." 🩸🧠

2/🧵
Introduction

What is the use of biomarkers? 🧠

Diagnostic tool🪓

Tool for staging the disease 🥼

Indicator of prognosis📡

Predic or monitor of clinical response to an intervention🚨

Remember: "tools"should aid clinicians, not be the source of all truth.

3/🧵
Read 14 tweets
Dec 6, 2022
Dementia with Lewy Bodies:

Part 1️⃣ Clinical features and Probable Diagnosis
🧠📚🔖

#Neuro #Neurotwitter #Teaching #Education

#NotEverythingIsMemory

#Dementia

1/🧵
Introduction 🥇

DLB belongs to a family of disorders typically known as "synucleinopathies" 🔬

Other members are:

- MSA
- PD
- PDD

All of them have abnormal inclusions of α-Synuclein at a pathological level.

2/🧵
⚠️⚠️⚠️
"Pathology is not pathogenesis", therefore we shouldn't assume that the presence of these pathological changes are a synonym of "protein toxicity".

Suggested reading ⬇️

jamanetwork.com/journals/jaman…

3/🧵
Read 24 tweets

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