Can't wait to nerd out with the
@CLENeurons
family.
@NMatch2022
#NeuroTwitter
I am grateful to everyone who helped me along this long, arduous, yet life-changing journey.
I did the Dix hallpike maneuver, it was positive. It's BPPV!
Right ? 🧠🤯👂🫨
Wrong!!
Here's a list of red flags in a Dix hallpike maneuver that should make you think of central vestibular dysfunction. 🧵1/4
Just finished an interview where the PD appreciated my application & LORs. She was curious about the medical system in India and genuinely wanted to get to know me. We discussed global health although it's not her field. I feel grateful!
@NMatch2022
@IMG_Advocate
#globalhealth
A senior physician I worked with lost his mom in his home country while he was seeing patients in his clinic in the US. "I didn't have a choice but to put a straight face and continue working that day" he said. "I felt guilty, I should have been there for my parents"
Just like that, I signed my first note on Epic. I've waited for this day ever since my first visiting rotation. SO MUCH to learn. Epic, be kind to me 🙏🙈
#NeuroTwitter
#Neurology
#MedTwitter
Neurological conditions that are mediated by IgG4 antibodies:
-LGI1
-IgLON
-Nodopathy and paranodopathies
-MUSK MG
Here's an interesting paper on why knowing this matters. Briefly, IgG4 mediated disease respond minimally to IVIG, steroids or even PLEX.
Nothing says Neurology more than getting a ➕ dix-hallpike test on a dizzy patient and avoiding a several thousand dollar TIA/spell work up. Neurology, I have arrived ! On to PGY2! 🥹🤗🧠❤️
#neurotwitter
#MedTwitter
I have alot to be grateful for,but today I'm going to admit that I'm proud of myself. The
@ImgJourney
is not easy. We all go through so much more than what's visible on our application. I have worked towards
@NMatch2022
for 7years and I can't wait to live my dream!
#NeuroTwitter
I was today years old when I learned that Carbamazepine can induce statin metabolism and lead to elevated LDLs.
Relatively preferred statin in patients on Carbamazepine is: ROSUVASTATIN. 💊🧠🤯
#neurotwitter
#MedTwitter
#epilepsy
Patient with subacute imbalance, neck pain, brisk reflexes, and mild abnormalities on sensory exam.
Easy, it's a c-spine myelopathy.
SURE! but did you know the classical sensory exam finding for Cspine compressive myelopathy?
#neurotwittwer
🧵1/4 🥴
PMID:38213348 Saunders et al
Your patient has a facial numbness that doesn't respect the V1,V2,V3 distribution. What to do next ?
#NeuroTwitter
🧠😅
See if it localizes to the ipsilateral spinal trigeminal nuclei !
The trigeminal nuclei in the brainstem are arranged in an onion bulb pattern. 1/2 🧵
Cool fact - Some hypercoaguable conditions make clots stick to their veins of origin, preventing them from embolizing. Example - Factor 5 Leiden paradox: Pts have more DVT but are less prone to getting PEs(than would be predicted). Other eg- OCP💊, 🤰.
#MedTwitter
Officially PGY2's !! Get ready for our puppy energy. I'm grateful to have had so much learning in medicine and can't wait to immerse myself in all the neurology.
@CLENeurons
🧠🐶🐾❤️
#MedTwitter
#neurotwitter
Fascinating case discussions at AAN summer conference. Hughltigunt a few pointers;
-Hypoglycoryccha is a red flag for autoimmune encephalitis !
-Not all granulomas are sarcoidosis- think lymphoid granulomatosis, lymphoma, Granulomatous vasculitis, Infection etc.
That victory moment when you're finally able to spot cranial nerves on the MRI and have an opinion on whether it's enhancing or thickened!! That's my
#neurophilila
moment of the day 🤩 🧠❤️
#neurotwitter
#MedTwitter
Finished my first
@GhoshAmitav
book today! It feels like I've been in the Tide country for weeks. I'm left feeling sad, displaced and wanting more. What a masterpiece!
#grateful
Remembering my grandad on
#WorldParkinsonsDay2023
. You were a strong fighter and I can't help but notice sparks of you in every PD patient I see. Wherever you are, I am sure you are entertaining everyone with your disinhibited jokes.
#neurotwitter
#neurophilia
#Parkinson
🧠❤️
Diagnosed my first ever optic disc edema with classic drusen and cotton wool spots consistent with Hypertensive retinopathy. Feels good to be able to use an Ophthalmoscope finally!
Baby steps 🌸😁🧠🤯
#grateful
#neurotwitter
#MedTwitter
Just learned about a cool new clincial sign:
Bendopnea : Shortness of breath on bending. It is a sensitive finding for severe Pulmonary artery hypertension.
So neurologists arent the only ones with a nack for clever terminology. 🤔🧠🫀
#neurotwitter
#Cardiotwitter
#MedTwitter
A
@NMatch2022
program coordinator just reached out for a noise check!She asked if we were expecting Diwali fireworks during our interview tmrw and if it would be inconvenient.
Thank you for being so thoughtful! Wow, PCs really are the unsung heros
#NeuroTwitter
#Neurodiversity
"While the bacteria constantly mutate, humans have remained prisoners to their biases-race, cast, and class-depleting our capacity to keep pace with this evolving foe." - Vidya Krishnan
#MedTwitter
#IDTwitter
#AcademicTwitter
Nystagmus in Dix hallpike for BPPV patients is less consistent. Whereas it is more consistent in central vestibular dysfunction. 🧵 4/4
Also, have you heard of Semont plus maneuver?
Source: DeJong's Neurological examination.
Just learned and admitted a case of parainfectious NMDA encephalitis with HSV encephalitis. Is this common ? 🤯🧠❤️
PS- NMDAR AB in the CSF 1:5 Titre via a CBA.
#neurotwitter
#MedTwitter
A patient on day3 of his occipital stroke said he saw vivid colours on half his visual field that felt like a Disney princess was running and left behind her pixie dust trail 🧚♀️🧚🧚♂️
Evolving infarct vs seizure? Don't know, but that's a beautiful way to describe it!
#neurotwitter
Reading about all the amazing faculty that are taking time out to interview and get to know me. Their awesome neurons have worked on path breaking research and witnessed the rarest diseases. I'm grateful and incredibly excited!!
@NMatch2022
#neurotwitter
#Match2022
@IMG_Advocate
I met
@TheresaErmer
2yrs ago while rotating at
@MayoClinic
. She was an aspiring(and now soon to be)surgeon and I was on a neurology rotation. We metup last weekend and I'm still floored by her grit and brilliance!Thankful to
@MayoClinicNeuro
@MayoClinicSurg
for connecting us!
The Split hand is a commonly known ALS sign. Did you know about the Split leg sign in ALS ? ✋
Asymmetrical wasting of muscles involved in dorsiflexion compared to plantar flexion. It is the reason why foot drop is a common presentation of ALS. 🦵🧠🪢
#neurotwitter
#MedTwitter
Thank you
@CLENeurons
for the sweetest gesture on my birthday! Next time, IL remember to wear the cowboy hat on rounds. Haha
#grateful
#neurotwitter
PS - There's a bag full of candy underneath that hat. 🍭
It's so exciting to see everyone start with their new jobs, residency, and continue to grow in their life.
As I start PGY3 year in Neurology, my aims are:
-continue to learn every single day
-learn to nurture
-be the best team player.
#Neurotwitter
#pinchme
#MedTwitter
GTCS mimickers :
-Stoke Adams syndrome: post anoxic brain injury or vasodepressor syncope
EEG will be ⏬ amplitude and frequency ⚡
-Limb shaking TIA(one sided)
-basilar artery occlusion (ischemia of corticospinal tract?)
- breath holding spell or fainting lark
#neurotwitter
Me coming back after having a long conversation with the patient about optimizing their nutrition, GDMT, and exercise. 🙈🤤
#iykyk
#MedTwitter
#guiltypleasure
Did you know the CSF for CMV could be neutrophilic predominant ?
Clinical phenotype : myleoradiculitis, encephalitis, retinitis.
#neurotwitter
@AANmember
Celebrated the end of my residency interviews with an amazing orchestra experience.
All that jazz with the amazing
@byronstripling
and Cleveland pops😀😮🎷. My neurons deserved it 🧠❤️
@NMatch2022
Ive heard about CLIPPERS but I was today years old when I learned about SLIPPERS !
@AANmember
Ddx- Primary central nervous system vasculitis, lymphoma, neurosarcoidosis, granulomatous diseases, including GFAP.
See more :
#neurotwitter
Just learned that my alma mater, Calcutta national medical college performed it's 1st thrombolysis. Patients' NIHHSS improved from 5 to 2. This is HUGE.
Today in the NICU - while a resident was putting in an art line, the patient complained of feeling lightheaded... After 1-2 min, his symptoms continued and he began yawning..
He wasn't sleepy or tired, just yawning 🥱
#NeuroTwitter
why do you think this happened ?
#MedTwitter
If you are a program outside the USA, consider joining on a future Saturday.
Much gratitude to
@MariaMjaleman
for the wisdom to think of this and the hard work to make it happen.
Can’t wait to see my friend
@hecarrillo
!
THRILLED to introduce the class of 2027
@CLENeurons
🧠! We are so excited for you all to join our family, & we can’t wait to be a part of your ongoing incredible journeys. Now go celebrate & relax! 🎉
#neurotwitter
#nrmpmatch
Let's enumerate the false localising signs in
#Neurology
-Bilateral CN VI palsy:can be sign of raised ICP, or pericavernous lesions 🥹👀
-paradoxical hemiplegia:hemiplegia on the side of the stroke, sign of transtentorial herniation🧠
Are there more
#NeuroTwitter
?
#MedTwitter
Thoroughly enjoyed MICU with
@LaurenGranat
. The ICU can be overwhelming for any intern. Thank you for the teaching, making me feel safe, and letting me have a voice! You're going to be such a great chief and
@CCF_IMCHIEFS
is so lucky to have you. Il miss these messages❤️🥹
Every time I'm wrong in residency(especially as a junior), I'm Happy! I learned something that I hopefully won't forget without causing any harm to the patient. It's a win winnn!
#Grateful
#neurotwitter
🧠❤️
Saw a case of Jeavons syndrome where the onset of seizure was generalized but it progressed to have a focal semiology. Confirmed on EEG and clinically. Fascinating.
Have you seen this before ?
#neurotwitter
#MedTwitter
What are some neurological findings that get more obvious with colder temperatures ?
- Myotonia gets worse
- Ice pack test in myasthenia gravis
- migraine with temperature differences
Have you heard of seen any more ?
#neurotwitter
#medtwitter
When life showers rain on you, you seek out the rainbows !
Had a terrible 24hours with travel delays and the Midwest storm.
Amidst all this, I was able to see one of my childhood dream institutes and the cherry on cake was the double rainbows🌈🌈
#Grateful
#MedTwitter
#neuropearl
:
Adies syndrome 👀👁️🕵️
Etiology: viral infection of the ciliary ganglion.
Why is accommodation preserved but light reactivity impaired?
Because the ciliary ganglion sends more neurons to innervate the ciliary muscle compared to the iris.
#MedTwitter
#neurotwitter
What does non fluent in Broca's speech mean ?
The speech has grammatical errors, short sentences, lack of melody and agility(impaired prosody) and lesser words per minute!
#neurotwitter
#medtwitter
Thank you
@AmEpilepsySoc
for the amazing Resident EEG course! I'm learning so much and HIGHLY recommend it to every neurology resident! 🧠❤️ Loving the squiggles!
@yesILAE
#NeuroTwitter
Why does your patient with a PCA infarct have amnesia ?
NO, Its not toxic metabolic encephalopathic. It's the involvement of Hippocampus and mesial temporal lobe that get supply from PCA too.
#noteverythingisencephalopthy
@AANmember
#aanam
Have you considered the Off label use of your residents' time to discuss and find Meaning in Medicine? Highly recommended by us
@ClevelandClinic
. 😄
Grateful to have spent the evening with such passionate, empathetic, and intelligent co-workers!
#MedTwitter
#neurotwitter
Epilepsy 🦪
Where can we localize Ictal apnea?
Involvement of the amygdala respiratory inhibition center causes ictal apnea.
Commonly associated with tachycardia, but bradycardia is also seen.
#MedTwitter
#epilepsy
#neurotwitter
Yesterday in the ED - An elderly woman was petrified after finding out she had pancreatitis. No amount of medical explanation helped. She kept saying "oh Lord have mercy". I switched gears and held her hands and prayed with her. 1/3🧵