Need help remembering how to compute a Glasgow Coma Scale (GCS) score?
 
A thread:

How to quickly and reliably compute GCS without having to look it up every time 😎👇🧵🧠

/1 The Glasgow Coma Scale (GCS) was first published in the 1970s and was intended to describe a patient's level of consciousness following traumatic brain injury.

/2

General principles of cranial stabilization for neurosurgical procedures – a thread 🧵

/1 Intraoperative head stabilization is often performed by pinning. Careful & thoughtful consideration is required to
 
-avoid complications
-optimize access to surgical target & minimize steric hindrances
-support devices for stereotactic neuronavigation or retraction

/2

External ventricular drains (EVDs) are one of the most common procedures in neurosurgery… And having to troubleshoot said EVDs that stop working (usually in the middle of the night) is ALSO common, though not always intuitive 📟🫠

How to troubleshoot an EVD - a thread 🧵 /1 First, let's review how EVDs work. An EVD is a temporary catheter placed in the ventricle at the foramen of Monro that can (1) measure ICP & (2) control ICP by draining CSF.

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1/ Have you ever had a patient with low back pain & degenerative findings on lumbar MR imaging? 🔎👀

Demystifying lumbar stenosis is one of my favorite things to teach medical students & junior residents!

A thread 🧵 2/ Let’s review the normal anatomy of the L3-4 spinal segment.

🟡 Mid-sagittal: we see the central canal w/ the thecal sac, containing nerve roots distal to the conus.

🟠 Parasagittal: the lumbar nerve roots exit below their respective pedicles via the neural foramina.

You're paged emergently about an incoming patient with a suspected brain injury.

What are the first things you need to do?

A review of the emergent evaluation of a patient with traumatic epidural or subdural hematoma
🧵🧠👇 1. Advanced Trauma Life Support (ATLS) primary survey (airway, breathing, circulation, etc.).

2. Rapid neurologic assessment with a validated coma scale (either GCS or FOUR score). Prior to exam, confirm paralytic reversal with train of fours and pause sedation.

One of the most common consults we see in neurosurgery is the 'cauda equina syndrome (CES) rule-out.' CES can be diagnostically challenging & panic-inducing due to its highly variable presentation & grave consequences if missed.

How to evaluate suspected CES: a thread 🧵

(1/9) (2/9) When cauda equina syndrome is suspected, investigate the following:

•History (always)
•Bladder function (PVR)
•Rectal exam (3 parts: perianal sensation, voluntary contraction, wink reflex)
•Neuro exam (sensorimotor, reflexes)
•Imaging (MRI)
 
Let’s dive in 👇

Elie Wiesel gave the commencement speech at my college graduation - 'Memory and Ethics.' His words are as germane as ever. A thread 🧵

"One thing I can tell you: You see that road there? Don’t go there. I have just come from there..." (1/7)

(2/7) "...I belong to a generation that tells you that. The 20th century was one of the worst centuries in the history of humankind. Why? Because it was dominated by two fanaticisms. Political fanaticism. Racist fanaticism. That century caused more deaths than any time before."

When I was a PGY-1, neuro-oncologist Dr. Darin Carabenciov taught me a quick yet systematic approach to MR imaging of brain lesions. I am on call this weekend and am still utilizing his teachings to this day! A thread: (1/7) In general, there are 4 MR sequences that will tell you 99% of what you need to know:

1. T2 FLAIR
2. T1 post-contrast
3. DWI
4. GRE/SWI/SWAN/T2*

Thinking of going to medical school but worried about taking a "nontraditional"route?

A thread (1/8) I was 25 when I started medical school. I had spent 3 years after college pursuing music professionally, teaching piano, playing in a band, & working in a lab. I remember wondering if I was going to be behind the curve, if I was "too old" to start. (2/6)