Neurology resident at Indiana University. Full time nerd.
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Feb 8 • 8 tweets • 2 min read
What is Romberg’s sign and how should it be used?
I often see this sign misused to suggest a cerebellar ataxia. But it’s the exact opposite - the test exists to point AWAY from central cause!
Explanation below ⬇️
HISTORY
Moritz Heinrich Romberg was a pioneering German neurologist who’s focused on one of the most important diseases of the time: syphilis. Without effective treatments, syphilis could cause tabes dorsalis, a degenerative disease of the spinal dorsal columns.
In a cardioembolic stroke, a blood clot starts in or passes through the heart but ends up in the brain. It’s managed differently than the other two types we’ve covered. Let’s jump in!
#neurotwitter #neurology #MedEd #FOAMed
Cardioembolic strokes are generally caused by the other two corners of Virchow’s triad: stasis (eg afib) and hypercoagulability (eg paradoxical embolus from a DVT). Overactivity of secondary coagulation results in a thrombus which can embolize.
Dec 5, 2023 • 14 tweets • 5 min read
INPATIENT WORKUP OF STROKE
Pt 2: Small vessel disease
If there’s large vessel (atherosclerosis), you know there must be a small vessel category. Join me as we work through another major category of stroke!
As before, we will be following the TOAST framework. While the trial itself bears little significance today, the framework it used to categorize strokes is a very helpful cognitive tool and has been repeatedly used in subsequent research.
Dec 3, 2023 • 13 tweets • 4 min read
INPATIENT WORKUP OF STROKE
To many, stroke admissions are not very exciting: it’s formulaic with the same tests ordered every time. But if you understand the reason behind the tests, it becomes much more interesting! Let’s explore together.
#neurology #meded #stroke #FOAMed
Back in the 1990s, there was a study called the TOAST trial that categorized strokes by mechanism. That framework is very helpful to this day and I’ll be using it here.
This thread will focus on the most common cause: large artery atherosclerosis (LAA)
Mar 4, 2023 • 10 tweets • 5 min read
I'm a collector, a neurology nerd, and a history fan by nature. The result of all of those is that I now own every major type of #neurology reflex hammer, and I've done the work for you to rank them.
Check out my reasoning below.
#neurotwitter#medtwitter
Tromner (S)
It's simultaneously the Cadillac and the Toyota Camry of reflex hammers. Most (American) neurologists carry one for a simple reason: it's the best. Best length, best weight, pointed tip for Babinski sign... There's really nothing negative to say.
Nov 12, 2022 • 9 tweets • 3 min read
PSA: don't withhold a QT prolonging drug just because the computer calculated a QTc above 450-460 ms. The computer correction is usually (>50% by the study below) very inaccurate. And it only takes 15 seconds to do it right (or at least better).
PMID: 27317349 #MedEd#tweetorial
Background: QT intervals change depending on HR. To compare them, one can correct for HR using many different formulas:
- Bazett
- Hodges
- Fridericia
- Framingham
- Rautaharju
Sep 6, 2022 • 9 tweets • 4 min read
There are a lot of jargon words in #neurology. As a student, I felt particularly confused by the words clonus, myoclonus, and asterixis, so I made this #tweetorial for learners who feel like I did. #MedTwitter#MedEd#medicalschool#neurotwitter
Clonus is RHYTHMIC involuntary muscle contractions. It's caused by lesions to the pyramidal tract (ie UMN). It's likely due to exquisitely hyperreflexic muscle stretch reflexes - basically the muscle contraction triggers itself to keep firing in a feedback loop.
Apr 21, 2022 • 10 tweets • 3 min read
Learning brainstem #neuroanatomy would be nearly impossible without the rule of 4s. I'm going to pass this along for anyone trying to learn #neurology, as this might be the single most powerful mnemonic I know of.
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