Celia Romero

MIR Neurología 🧠

[Salvador Pedraza @salvasapedraza]

Gonçalves, J., Rodrigues, A., Pires, R. et al. Ependymal enhancement on MRI: imaging patterns and diagnostic algorithms - a pictorial essay. Neuroradiology 68, 167–180 (2026). https://t.co/aM9BqyZGy8

[Dr sthanu subramanian @drsthanus]

A summary of different CNS Contrast Enhancement Patterns visible on MRI scans.

https://t.co/qGlpQCEKNv

[TereVG @terevallesmm]

Ese panfleto que has firmado con los sindicatos que NO NOS REPRESENTAN lo puedes ir quemando.
#MonicaGarciaDimision
#EstatutoPropio
#EstatutoMedico
#HuelgaMedica

[MedicoNotes @MedicoNotes]

🧠 STATUS EPILEPTICUS: Emergency Management (For subscribers only)

1️⃣ Definition & Urgency
🔸 >5 min seizure OR
🔸 Recurrent seizures without regaining consciousness
⚠️ Mortality: 10–20% (higher if untreated >30 min)

2️⃣ Common Causes (Mnemonic “ABBA”)
▫️ Alcohol withdrawal
▫️ Benzodiazepine withdrawal
▫️ Barbiturate withdrawal
▫️ Anticonvulsant non-compliance

3️⃣ Diagnostic Workup (ABCDE)
▪️ ABG (acidosis?)
▪️ BMP (Na+/Ca2+/glucose)
▪️ CBC (infection?)
▪️ Drug levels (antiepileptics)
▪️ EEG (non-convulsive status?)

4️⃣ Treatment Timeline
⏰ 0–5 min:
•ABCs (Airway! O2, IV access)
•Check glucose (D50 if <60)

⏰ 5–20 min:
•1st-line: IV lorazepam (0.1 mg/kg)
•Pediatric: Intranasal midazolam

⏰ 20–40 min:
•2nd-line: Fosphenytoin (20 PE/kg)
•Alternative: Valproate/Levetiracetam

⏰ >40 min (Refractory):
•ICU: Propofol/midazolam coma
•EEG monitoring (burst suppression)

5️⃣ Complications
▪️ Neurological: Hippocampal necrosis
▪️ Systemic: Rhabdo, hyperthermia, ARDS

📌 Mnemonics
🔹 “STATUS = Stabilize Then Antiepileptics Timed Urgently Systematically”

—————

🌐 Visit our website for high-yield medical notes: https://t.co/2UQyCbb6in

—————
#usmle #neurology #MedicalEducation #DoctorsOfInstagram

[Practical Neurology @PracticalNeurol]

🧠🎧 New PN Podcast
🟪 A face in the hedge: Dementia with Lewy bodies
Pareidolia, passage hallucinations & “the company it keeps” - how do we pin down DLB?
From gait clues to word-finding pauses, biomarkers & practical management pearls.
🍎 https://t.co/eFRGPR2fBO
🟢 https://t.co/rGqYmYnIjs
🌐 https://t.co/Zi011CPKeA
#Neurology #PracticalNeurology #NeuroTwitter #MedTwitter #MedicalPodcast #DLB #Dementia #LewyBodies

[MedicoNotes @MedicoNotes]

🦠 MENINGITIS: What You Need to Know

🔬 PATHOGENS BY AGE GROUP

Bacterial (EMERGENCY! 🚨):
•Adults: Streptococcus pneumoniae (1)
•Teens: Neisseria meningitidis (1)
•Neonates: Group B Strep + E. coli
•Others: H. influenzae, Listeria (immunocompromised)

Viral (“Aseptic”):
•Most Common: Enteroviruses (Echovirus, Coxsackie)
•HSV-2, HIV-associated (Cryptococcus, CMV, TB)

⸻

⚠️ CLASSIC TRIAD (50% of Cases):
•Fever + Headache + Neck Stiffness
Other Symptoms:
•Photophobia ☀️, Seizures, Nausea/Vomiting
•Meningeal Signs:
•Kernig’s: Thigh flexion → Pain on knee extension
•Brudzinski’s: Neck flexion → Knees/hips flex

⸻

🩺 DIAGNOSIS

1️⃣ Lumbar Puncture (LP):
•CSF Analysis: WBC/protein/glucose, Gram stain/culture
•Viral PCRs (e.g., HSV), Cryptococcal Ag (HIV+)
2️⃣ Neuroimaging (CT/MRI) before LP if:
•Altered mental status, papilledema, focal deficits
3️⃣ Bloodwork: Cultures, CBC (↑WBC)

⸻

🚨 RISK FACTORS
•Recent ear/sinus infection 👂
•Immunodeficiency (HIV, chemo)
•Crowded settings (dorms/military)
•Neurosurgery 🏥

⸻

💡 KEY TAKEAWAYS
•Bacterial = MEDICAL EMERGENCY → Start empiric antibiotics ASAP!
•Viral = Less severe (supportive care).
•HIV patients? Think Cryptococcus, TB, CMV.

⸻

📚 Visit our website for more innovative medical notes: https://t.co/2UQyCbb6in

#medicaleducation #USMLE #medicine #neurology #doctorsofinstagram

[MDS @movedisorder]

Hospitalized PD patient with sudden rigidity, confusion, or fever? Think acute dopamine depletion. In this Mayo series, triggers included levodopa withdrawal (27%), antidopaminergics (33%), sepsis ± withdrawal (34%), and DBS failure.

Remember:
• Never interrupt levodopa
• Avoid antidopaminergics
• Always rule out sepsis
https://t.co/Sekpy8dMhZ

[Lea Alhilali, MD @teachplaygrub]

Feeling stuck in the middle when it comes to middle cerebral artery infarcts?

It may be only one vessel, but you can get many different infarct patterns & symptoms depending on where it’s occluded!

Here’s what you NEED to know:

FIVE MAIN INFARCT PATTERNS

1. Occlusion of the MCA stem or proximal M1 segment before the lenticulostriate origin
--Involves deep & superficial territories
--Weakness is usually severe. Face, arm, & leg are similarly affected
--Remember: Whole MCA occlusion = Whole hemiparesis

2. Lenticulostriate artery (LSA) Infarcts
--Involves deep territory
--Hemiparesis, hemisensory, occasional aphasia & visual hallucinations
--Remember: LSA stands for Limp (weakness), Sensory deficits, & occasional Aphasia

3. Distal M1 segment occlusion after the LSA origin
--Involves whole superficial MCA territory
--Sometimes weakness in face & arm > leg (brachiofacial hemiparesis)
--Remember: Distal MCA occlusion can somewhat spare the DISTAL most extremity (leg)

4. Superior Division occlusion
--Uncommon bc superior trunk is so short
--Involves frontal & anterior parietal lobe, including pre- & post-central gyri
--Prominent faciobrachial hemiparesis w/matching hemisensory
--Rarely visual field defect
--Remember: Superior is more = more pronounced motor deficits than inferior division

5. Inferior Division occlusion
--Involves temporal gyri & superior/inferior parietal lobule
--Facial brachial weakness is more mild than w/superior division
--Common visual field defect (homonymous hemianopia or upper quadrantopia)
--Remember: Inferior is less, so motor deficits are less pronounced
--Remember: Inferior starts w/the letter “I” = “eye” so visual field deficits

Hopefully now your reports won’t middling when it comes to middle cerebral artery infarcts!

[Dr. Abhishek Gohel @abgohel]

Aphasia --- High Yield!

Neurology Boards

[XRP Ledger Announces @XRPL__A]

This is an eye-opening study for me... Apparently, cerebrovascular hyperemia and /or vasospasm can occur in reversible cerebral vasoconstriction syndrome (RCVS). They may even coexist in different vascular territories or at different times in the same patient.

In RCVS, the hallmark is multifocal cerebral arterial vasoconstriction, which can progress and lead to ischemia and infarction.
At the same time, some regions can show vasodilation and impaired autoregulation with vasogenic edema, often overlapping with PRES, reflecting a hyperemic or “leaky” circulation pattern rather than pure spasm.
A mixture of distal vasodilation, proximal vasoconstriction, edema, and ischemia is well described, making it difficult to cleanly separate hyperemia from vasospasm. Indices like the Lindegaard ratio can help distinguish hyperemia from vasospasm rather than assuming only one process is present. A Lindegaard ratio of < 3 suggests hyperemia and > 7 is s/o vasospasm.

[Jamir Pitton Rissardo @theneurolander]

Dizziness

David Newman-Toker, neuro-otology
Senior author of "HINTS to diagnose stroke"

1/

[Dr. Abhishek Gohel @abgohel]

Falls in Neurology - At a glance

[CME INDIA @CMEINDIA1]

Sign of the day

ROGER’S SIGN
(NUMB CHIN SYNDROME)

Also known as Mental nerve neuropathy

Salient features
Facial & oral numbness rarely pain restricted to the distribution of the mental nerve of the inferior alveolar nerve.

It may be considered as RED FLAG symptom of a distant malignant neoplasm.

It’s associated with neoplastic processes
- Breast cancer
- ⁠lung cancer
- ⁠malignant lymphoma like
Burkitt lymphoma
- ⁠malignant metastasis to the head & neck

Mechanism
- Metastasis to Mandible
- ⁠Dural involvement of 5 th nerve at the base of the brain.

Non malignant causes include
Dental causes odont- iatrogenic ( most common)
DM
Sickle cell anemia
Vasculitis
Demyelinating diseases

Dr. Prabhakar K
Prof of Medicine
SDUMC, Kolar.

[Oren Gottfried, MD @OGdukeneurosurg]

Reflexes

[CardioMotorizado @EmergPOCUS]

🧠 Cómo usar el Doppler transcraneal en urgencias (sin complicarte) paso a paso 🧵

Es una herramienta:
• No invasiva
• Rápida
• Repetible
• En tiempo real

Su aplicación mejor estudiada 👇
👉 Vasoespasmo de la arteria cerebral media en HSA

📊 Comparado con angio-TC:
• Sensibilidad y especificidad 89–98%
• Excelente herramienta de monitorización a la cabecera

🧠 Además puede ayudar en:
• PIC elevada
• Desplazamiento de línea media
• EVC
• TCE (pronóstico)

📌 Ideal en pacientes inestables o con recursos limitados.

#Emergencias #POCUS #Neurocríticos #Urgencias #MedicinaCrítica

[Makindo Global Medical Education App @Foamed2020]

Acute Stroke Guidelines 2026

[Seraj Ajaj @seraj25]

From https://t.co/M5hF1ObFJW

[StudyXing Medicine @USMLEStepStudy]

Tardive dyskinesia - delayed-onset hyperkinetic movement disorder; MCC: chronic dopamine receptor blockade (long-term antipsychotic or metoclopramide use) —&gt; dopamine receptor supersensitivity in basal ganglia

[Aravind Palraj @Rheumat_Aravind]

Cryoglobulinemic vasculitis is not just a rash.
It’s immune complexes, complement consumption, kidneys, nerves - and often Hepatitis C driving the disease.

Low C4 should always make you pause.

#Vasculitis #Cryoglobulinemia @DrAkhilX @IhabFathiSulima @@#Rheumatology #MedTwitter #CHCC