Idiopathic intracranial hypertension (IIH)

This relatively common disorder is an important secondary cause of headache and can cause permanent vision loss. Let’s dive into the presentation, work up, and diagnosis together!

#neurology #FOAMed #MedEd #neurotwitter #tweetorial IIH is a syndrome characterized by CSF hypertension which is not due to obstruction or other mass-occupying lesion.

The prevalence is about 1 in 100,000 in the general population, but it’s 20 times more common in the highest risk population, obese women < 45.

NEUROLOGICAL APPROACH TO DIZZINESS

Dizziness is one of the most common reasons for a neurology consult. The murky waters of the vestibular system are scary to us mere mortals. But having a framework provides a map to sail these choppy seas!

Thread below: The first step, we’ve all been told, is to find out what a patient means by dizzy:
⁃Vertigo
⁃Presyncope
⁃Imbalance
⁃Other
When it comes to acute dizziness, we neurologists tend to care most about vertigo.

FIRST TIME SEIZURE

Anyone who spends time on an inpatient neurology service knows this is one of our top 5 consults/admits. This thread will break down the workup and the decision of who needs to be on antiseizure medication (ASM).

#neurology #FOAMed #neurotwitter The first step: was it really a seizure?

Common mimics of seizures:
- Syncope (esp convulsive syncope)
- PNES/functional seizures
- Behavioral staring spells (esp in kids)
- Stroke/TIA
- Movement disorder

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.

INPATIENT STROKE WORKUP
Pt 3: Cardioembolic strokes

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

https://twitter.com/isaaclamb01/status/1732156075929940240

PATHOPHYSIOLOGY

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.

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!

#neurology #MedEd #FOAMed #neurotwitter #tweetorial

https://twitter.com/isaaclamb01/status/1731364492825465296

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.

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)

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.

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

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.

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.

I present to you, The Rule of 4s: a #MedEd #tweetorial

(1/10) 4 cranial nerves per brainstem level
- Midbrain: 1-4
- Pons: 5-8
- Medulla: 9-12

* CNs 1 and 11 do not connect with the brainstem
* CN5 enters in the pons, but has nuclei at all three levels

(2/10)