Blink & miss.
57♀. T2DM. Referred for evaluation of possible partial right 3rd cranial nerve palsy of 2 days.
Can we pick up the culprit?
MR brain☞ DWI/ADC👇.
T2/T1 in 🧵
(1/13) MR brain T2/T1 👇
(2/13)

45♀. 45Kg.
1Y. Gradually↑: Unable to get up from ground. B/L hand tremors.
LE weaker > UE.
Lost a few kilos.
Darkening of skin, ↑ from her previous color👇
?clubbing.
Flushing of palms.
DTRs ↓
#neurotwitter #NeuroX #MedTwitter #MedX #Neurology #FOAMmed
A 🧵 She had come w/ some investigations done over past 6M.
HIV/HCV/HBsAg -ve.
CBC/LFT/KFT N (multiple).
TSH 7.4 (Ref: 1-5).
ANA -ve.
NCS: 👇

15 ♀
Very peculiar.
Late December. She was taking ↑ than usual time to come out of bathroom. Knocked. No response. Door broken. Unconscious, drooling, naked. This scenario is not so uncommon for us clinicians of North India.
#neurotwitter #NeuroX #MedTwitter #MedX #FOAMed
🧵 Taken to a nearby hospital. ↑ restless & agitation.
“I cannot see” repeating like a parrot.
Came to us in this state ☞ 8 hours.
Restrained. Sedated.
CEMR brain < 24 hrs from onset.
Faint b/l occipital cortical DWI brightness w/ no definite restriction. No enhancement. DWI👇

Interesting #Neurology #Pediatrics cases. 🧵
When uncommon cases come, they come in pairs.
Case 1: 8♂. AFI X 5D. Scrub typhus +ve.
AKI. RRT X 3 sessions.
Developed seizures on D8.
MR 👇 #neurotwitter #NeuroX #MedTwitter #MedX #neuroradiology #MRI Case 1: There was no Gad enhancement or restricted diffusion.
Possibilities?

We were consulted for a 2nd opinion.
30F. D1. Deep dog bite L cheek while tending fields. Multiple others bitten. Dog was killed the same day by villagers. #NeuroTwitter #MedTwitter #IDtwitter #NeuroRad #Neurology D2. Visited PHC.
Prescribed PVRV (Abhayrab) D2, D5, D8, D13. NO RIG given.

Learning through mistakes.
(1/11) 38F. 90kg. No PMH. Fever x 3-4D ☞ body pains.
D6: frequent seizures. Multiple ASMs.
D7: CT head + CSF WNL.
D11: MR brain WNL (not shown).
D13: Repeat CSF WNL.
D16: Repeat MR Brain👇 faint b/l medial temporal hyperintensities.
Acyclovir ✅ (2/11) D19: shifted here.
Seizures ++, mostly over face w/ partial preserved consciousness.
Intubated. 4 ASMs ☞ Ketamine bolus ☞ infusion.
D19: IVIG + IV MPS also started.
Repeat CSF: routine normal. CSF BioFire -ve, including HSV. Acyclovir stopped.

7M. Had focal seizure 10m back after fever w/ eye signs. Dx as ADEM. Given IVMPS+ASM. Pt stopped Rx after 3m. Seizure recurrence after 10m w/ unsteadiness of gait. Both MR brain 👇 #neurotwitter #MedTwitter #ADEM @thecortexclub @Brandon_Beaber @LyellJ @TylerAllisonMD @MohitAgNeurorad @marignierro @DrCindyCooper @a_charidimou @Jagan1234 @HuttoSpencer @VMSilvera @drSurjthVattoth @LorenzoPinelli @LyellJ @rkchoi @bobvarkey @caseyalbin @OligoclonalBand @StaceyLClardy @mdsebaslopez @Sthanu5

Like to present a case seen in 2017. We were not aware of the entity then. 17F, 15D vomiting, headache. No deficit. Evaluated at institute. Extensive blood/CSF/tropical diseases workup -ve. CSF: P81, G57, cell 30 (all L). IVMPS x 5gm. Discharged with Dx of ADEM. 1st CEMR. (1/8) 8D later readmitted there w/ headache x 3D w/ mild rt ptosis. Again IVMPS x 3gm. Better. Again recurrence of headaches. Both times followup oral steroids not given. Came to us.
2nd CEMR. Similar findings. Slight increase in lesion burden. (2/8)

2nd case of this season. Found in bathroom in unconscious/confusional state. Small bathroom. To start w/ dizzy/headaches & attempt to open door but can’t. Inappropriate ventilation. Prolonged bathroom utilisation. Gas geyser fitted inside.
Same story every year this time around. Mostly wrongly diagnosed as seizure episode. My 1st case a decade ago & was pointed out by a GP: GAS GEYSER SYNDROME. Mostly the pt is found naked, females & Sikhs more likely because of long hair wash. Takes more time than usual seizure; prolonged confusional state. #MedTwitter