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Feb 4 • 8 tweets • 3 min read
An elderly man who repeatedly kicked the woman ahead of him while waiting in queue to board a flight

1. 69-year old Balu, while waiting to board a flight, started to repeatedly fling his right leg that hit the woman standing in front. The woman was shocked with this incident.
2. She was terribly upset and remarked-"just because boarding is delayed & you are restless, doesn't mean you can kick me like that. Moreover, you can't take advantage of you being older to me".
But Balu denied any wrongdoing and said the leg started shaking without his control.
3. As soon as Balu landed in Hyderabad, he consulted a physician, who diagnosed focal motor #seizures (fits) and started him on anti-epileptic drugs (AEDs). Similar symptoms repeated after one month despite being on regular AEDs, and he was referred for my opinion.
#Medtwitter
4. I reviewed his clinical details- he had no aura prior to these abnormal leg movements, no loss of consciousness, no tongue bite or lack of urinary control during these episodes- these ruled out seizures. These leg movements lasted only 1-2 minutes.
The diagnosis was obvious.
5. Mr Balu's diagnosis was limb-shaking transient ischemic attacks (TIAs).
I asked him to get carotid doppler done, which showed 80% stenosis (narrowing) of left carotid artery. He was at a high risk of getting #stroke in future that could have left him paralyzed.
#NeuroTwitter
6. He was referred for left carotid revascularization procedure to reduce the risk of stroke (paralysis) in future. The procedure was uneventful and he was discharged in two days. He was started on blood thinners and statins. Medicines for high BP and diabetes were continued.
7. He remained well after the treatment and had no further episodes of involuntary shaking of legs.
*Take home message:
Involuntary shaking of leg for a few minutes could be a sign of brain ischemia (lack of blood flow to brain) due to narrowing of carotid artery.
8. Further reading
doi.org/10.7759%2Fcure…

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More from @hyderabaddoctor

Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Feb 6
A common habit resulted in severe #vision impairment in a young woman

1. 30-year old Manju had severe disabling vision symptoms for one and half years. This included seeing floaters, bright flashes of light, dark zig zag lines and at times inability to see or focus on objects.
2. There were moments when she could not see anything for several seconds. This occurred mostly at nights when she got up to use washroom. She was evaluated by an #eye specialist and detailed evaluation was found to be normal.
She was referred to rule out neurological causes.
3. I reviewed the history. Symptoms had started after she quit her job of a beautician in order to take care of her specially abled child.
She picked up a new habit of browsing through her smartphone for several hours daily, including >2 hours at nights with lights switched off.
Read 13 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Feb 2
Running is not detrimental to #knee #cartilage

1. The general health benefits of #running are well-established, yet concern exists regarding the development and progression of #osteoarthritis
A recent research examined the effects of running on knee cartilage using MRI scans.
2. Knee cartilage thickness and volume decreased immediately after running, with declines ranging from 3.3% for weight-bearing femoral cartilage volume to 4.9% for patellar cartilage volume.
#MedTwitter #marathon #fitness
3. Tibiofemoral cartilage T2 relaxation times on MRI recovered to baseline levels within 91 minutes.
Existing cartilage defects were unchanged within 48 hours post-run, as examined on MRI.
Read 5 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Feb 1
Uncontrolled #epileptic fits stopped by #insulin

1. A man aged 75 had for five days experienced tonic-clonic #seizures involving the right side of the face and right upper and lower limbs at a frequency of 20-30 per day. He had mild weakness of right arm and leg.
#MedTwitter
2. Patient was admitted in ICU under Medicine Unit. MRI brain and lumbar puncture were normal. New onset diabetes was detected for which he was treated with subcutaenous insulin.
Fits persisted despite treatment with midazolam and phenytoin. He was referred for neurology opinion
3. Patient was conscious but appeared exhausted. Review of blood tests showed high glucose of 350 mg/dL and mildly low sodium levels.
The diagnosis was obvious by now.
Read 8 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Feb 1
Poor sleep quality and sleeping <7 hours during adolescence can increase the risk of multiple sclerosis later in life

1. A recent case control study done at Sweden looked at the association between sleep duration (& quality) in teens and risk of multiple sclerosis in later life.
2. Compared with sleeping 7–9 hours/night during adolescence, short sleep (<7 hours/night) was associated with 40% increased risk of developing multiple sclerosis (MS).
3. When patients rated their sleep quality during adolescence as poor, the risk of developing MS in later life increased by 50%.
Read 7 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Jan 31
Carefully observing a patient walk 20 steps gave clue to diagnosis

1. 1995- I was a first year MD Medicine PG at CMC Vellore.
35-yr old Rami from Midnapore had got admitted with fever of unknown origin of 6 months duration. No cause had been identified despite extensive tests.
2. It was a hectic day with 8 new patients admitted from emergency. It was past midnight, when I managed to examine Rami. During examination, she took a washroom break, for which she walked about 20 steps in all. After she returned to her bed, she was breathless .
#Medtwitter
3. She was unable to talk in complete sentences. Her pulse rate was 140/min. High #pulse rate could be partly explained by #fever, but it was beyond what was expected for a fever of 102 degrees Fahrenheit (pulse rate can rise by 10 beats/minute per degree rise in temperature).
Read 7 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Jan 31
Head Injury increases the Long-term Mortality Risk in Community-Dwelling Adults

1. Even a single #head #injury could increase the risk of all-cause #death by 66%, as reported in a long term (27 years) follow up study conducted in USA.
#MedTwitter
jamanetwork.com/journals/jaman…
2. The association between head injury and death over long-term was dose-dependent.
111% higher risk of death was noted with two or more head injuries as compared to 66% higher risk of death after one head injury.
3. Those with mild head injury had 2.12 times higher risk of death as compared to those with no history of head injuries.
The risk of death increased to 2.87 times, if the head injury was moderate, severe or penetrating (as compared to those with no head injuries).
Read 5 tweets

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