Aditya Ganguly MBBS MD Profile picture
Jun 10 6 tweets 2 min read Twitter logo Read on Twitter
A lot of referrals to neurology are basically what I like to call 'lazy' referrals.

For example, you get a patient with paraparesis and instead of performing a detailed clinical evaluation, you shotgun some MRI and NCS and send a quick referral to neurology.
Since these investigations are poorly chosen and poorly aimed, the end result is mass confusion where localization goes for a toss.

General medicine has been particularly egregious in this regard.
If your knee jerk reaction is to just get an MRI LS spine for every low back pain, don't be surprised when the patient then develops an LMN type of lower limb weakness. Low back pain can be severe in GBS.
In this particular case, I knew that the LS spine imaging had not been well thought out.

Why?

Because if you are suspecting an early polyradiculopathy, you will need contrast enhancement of the roots --> but only plain imaging was done in this case.
I can understand this sort of mistakes in small centers, but large teaching institutions should avoid this kind of 'lazy' referrals, especially from General Medicine which is the mother subject of all the subspecialties.
Have you any experience like this?

Kindly post in the comments below.

#Medtwitter
#neurotwitter

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More from @AdiG1993

Jun 10
An important teaching case

A 45 year old lady with significant vascular risk factors presented with hyperacute onset dimness in the L side of her field of vision, specially in the bottom half.

There is no other significant neurological or systemic hx.
Clinical examination revealed only a BP - 150/90, R arm, sitting position with confrontation perimetry showing an incongruent, incomplete L sided homonymous hemianopia.
A homonymous hemianopia localizes posterior to the optic chiasma where the nasal hemiretinal fibers decussate.

A L sided HH localizes a lesion to the R post-chiasmatic visual pathway.

Incongruency argues for a relatively anterior localization of the lesion ie away from cortex. Image
Read 10 tweets
Mar 30
Interesting case in the ward today!

37y male first presented 10 yrs back, with insidious onset, progessively worsening R loss of vision --> complete blindness by 6 months.

He now presents with similar involvement of the L eye.

No other neurological/systemic hx.
On exam,

Gen survey - NAD

Neuro exam

CN 2 - R sided only perception of light, L finger count at 4 feet with colour desat, fundoscopy - B/L optic disc pale, L eye temporal hemianopia

CN 3,4,6 - EOM full in all directions, both pupils mid dilated and sluggishly R to light
Rest of exam is NAD.

What is your localization and pathology?

#MedTwitter
#neurotwitter
Read 11 tweets
Feb 5
Spot diagnosis.

#MedTwitter
#neurotwitter
I have not shown any demonstration of muscle power here but this patient had grossly weak (1/5) shoulder girdle muscles, including the biceps brachii.
This is the classic 'man in a barrel' syndrome.

Muscle weakness occurs at 13 sites

UMN-
Cortex
Corona radiata
Internal capsule
Midbrain
Pons
Medulla

UMN+/-LMN - Cord

LMN-
AHC - 1° vs 2°
Motor root
Plexus
Nerve
NMJ
Muscle
Read 9 tweets
Feb 3
I am no nephrologist but I deal with the aftermath of inappropriate treatment with tolvaptan all the time.

This information is obtained from the FDA access data from 2009.

Look at the indications. Image
Many people forget that many patients who are being treated with tolvaptan are either on fluid restriction or are dehydrated.

This can be exacerbated by ADH antagonism --> severe aquaresis --> serum Na shoots up --> VERY HIGH RISK of osmotic demyelination syndrome aka CPM!
This is the grisly end result of inappropriate tolvaptan use.

Osmotic demyelination is a monster - it kills and maims.

Read 4 tweets
Dec 13, 2022
1) I have been on social media continuously since class 8 --> that was back in 2008.

I began with Orkut and I have tried everything from the usual suspects like Meta (FB), Twitter and Ig to Reddit, Snapchat, Twitch and recently Mastodon.

These are some observations I have made.
2) The man or woman who follows everyone and everything is not worth following.

Not everything/everybody is worth your time.
3) Don't expect/beg for followbacks

Its just very stupid.

Don't do it.

If you bring value to SM, you will get automatically get followers.
Read 12 tweets
Dec 12, 2022
1) The simplest thing that you can do to improve your/your family's health?

Use Google Tasks or a similar service to schedule periodic health checkups like blood pressure/weight check or blood sugar testing (if you don't do SMBG).
2) All habits require a cue.

These regular reminders will be the cue --> without a proper timely cue --> you don't have a concrete plan --> you don't have a plan --> you don't check --> you don't check --> you don't assess your health.
3) You don't assess your health and you pay the price.

The beginning of any good habit/ practice is to schedule a cue.

The cue ensures a habit of continual assessment.

Remember --> if you don't measure something, you can't improve it.
Read 5 tweets

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