LavaleFló

Valentina Floris
Medico specialista in Neurologia 🧠

[Michael Okun @MichaelOkun]

One of the messages from Joe Jankovic's outstanding Aspen Movement Course lecture today on autoimmune-associated movement disorders that stuck with me was the importance of resisting the temptation to over-diagnose rare conditions. With the growing awareness of anti-IgLON5 disease, many of us have probably been ordering the antibody test more often than we should. Joe reminded us that testing is most appropriate when the clinical picture includes the characteristic sleep disorder, which remains one of the strongest clues to the diagnosis. He also shared an important case where the MRI showed abnormalities, underscoring that imaging can occasionally be helpful, although MRI is normal in most patients with IgLON5 disease. Perhaps he and Alberto Espay's most practical pearl was one we should all remember in clinic: if a patient looks like they have classic progressive supranuclear palsy (PSP), they probably have classic PSP, not IgLON5 disease. As new biomarkers emerge, thoughtful clinical judgment remains our most valuable diagnostic tool.

[Neurology Journal @GreenJournal]

Teaching Video NeuroImage: Vertebral Artery Occlusion Presenting With Peripheral Facial Palsy and Bruns Nystagmus https://t.co/toYosHPUtA

#NeurologyRF

[Journal of Neurology, Neurosurgery and Psychiatry @JNNP_BMJ]

POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, M-protein and Skin changes) syndrome is a rare multisystem disorder where early identification is essential for better long term outcomes. Yet it is often misdiagnosed. Gonçalves et al review the condition here:

https://t.co/N1fOBPt5w5

And this is a related editorial: https://t.co/MYW28Lz5ym

[Ravi Kumar @RheumattDoc]

🧠 Cancer screening in idiopathic inflammatory myopathies (IIM)

🧭 Step 1: Identify IIM type
•Juvenile IIM / IBM → No routine cancer screening required
•Adult-onset IIM → proceed to risk stratification

⚖️ Step 2: Risk stratification

🔴 High-risk factors

Subtype
•Dermatomyositis

Antibodies
•Anti–TIF1-γ
•Anti–NXP2

Clinical
•Age > 40 at onset
•Persistent high disease activity
•Moderate–severe dysphagia
•Cutaneous necrosis

🟡 Intermediate-risk factors

Subtype
•CADM
•Polymyositis
•IMNM

Antibodies
•Anti-SAE1
•Anti-HMGCR
•Anti-Mi2
•Anti-MDA5

Clinical
•Male sex

🟢 Low-risk factors

Subtype
•ASSD
•CTD-associated myositis

Antibodies
•Anti-SRP
•Anti-Jo1
•Non-Jo1 ASSD antibodies
•MAA

Clinical
•Raynaud’s
•Inflammatory arthritis
•ILD

🧮 Step 3: Assign overall cancer risk

🔴 High risk
•≥2 high-risk factors

👉 Screening
•At diagnosis: Basic + Enhanced panel
•Follow-up: Basic screening at 1, 2, 3 years
•Consider:
•FDG PET-CT
•Upper & lower GI endoscopy

🟡 Moderate risk
•≥2 intermediate OR 1 high-risk factor

👉 Screening
•At diagnosis: Basic + Enhanced
•Follow-up: No routine repeat

🟢 Standard risk
•Does not meet above criteria

👉 Screening
•At diagnosis: Basic only
•Follow-up: None

🧪 What’s included in screening?

Basic panel
•History + exam
•CBC
•LFT
•ESR/CRP
•SPEP
•Urinalysis
•Chest X-ray

Enhanced panel
•CT neck/thorax/abdomen/pelvis
•Cervical screening
•Mammography
•PSA
•CA-125
•Pelvic USG
•FOBT

🌏 Special note
•Consider nasoendoscopy in regions with high nasopharyngeal carcinoma risk

🔑 Take home
•Dermatomyositis + TIF1-γ/NXP2 + older age = highest cancer risk
•Screening intensity is front-loaded at diagnosis, with follow-up mainly for high-risk patients

#RheumattDoc #MedTwitter #RheumTwitter #Medicine #rheumatology @DrAkhilX @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1

[Interesting STEM @InterestingSTEM]

Macrophage white blood cell eliminating pathogens

[Brandon Luu, MD @BrandonLuuMD]

Dog ownership was linked to ~40% lower odds of disabling dementia.

There was no protective signal for cat owners.

[Jack Garnham @jjgarnham]

🩺This young man presented after chiropractic manipulation with acutely worsening pain and nausea.

🩻He has multiple acute infarcts in the left cerebellar hemisphere and left thalamus, all in the territory of the left posterior circulation.
🩻The V3 segment of the left vertebral artery is dissected. Can you appreciate the tiny narrowed lumen and the eccentric hypoattenuating compressive intramural haematoma? This is a beautiful example.

💡Dissection causes 5 - 20% of strokes in young people. Internal carotid artery dissection is five times more common than vertebral artery dissection.
💡Healing and vessel remodelling occurs within 3 - 6 months. The stenosis will improve in the majority of patients and complete recanalisation can be seen in up to 50%.

[Neurology Journal @GreenJournal]

Pearls & Oy-sters: Reversible Leukoencephalopathy and Parkinsonism Due to CNS Involvement in Cryoglobulinemia https://t.co/A2h7hU3Nio

#NeurologyRF

[WalidoNeuroPedia @NeuroWalid]

An amazing diagram of antiseizure medications and their mechanisms of action.
#neurotip #epilepsy

Full article: https://t.co/UM0s5PnFnx

[Elia Sechi @EliaSechi]

Applying the Supporting Features for MOGAD Diagnosis to Patients With Multiple Sclerosis | Neurology Neuroimmunology & Neuroinflammation https://t.co/eqj2ot5yEf @PietroZara6 @MGastaldi85 @SaraMariottoMD @RosaCortese5 @CartaSra and Giacomo Greco 🇮🇹💣

[ECTRIMS @ECTRIMS]

📢 Breaking news: The 2024 revised #McDonaldCriteria have been published in @TheLancetNeuro. Explore the latest evidence shaping #MSDiagnosis. Published by the International Advisory Committee for Clinical Trials in #MS.
👉 https://t.co/8V2lWodMm2
@mssociety #MSResearch #IACCTMS

[Elia Sechi @EliaSechi]

In our recent study, the "Insular Knife Cut" Sign had 99.3% specificity for HSV encephalitis and was often detectable early after symptoms onset on brain MRI. An ominous sign not to miss in patients with suspected encephalitis of new onset!!! https://t.co/l6jrmxHeHV

[Neurology Journal @GreenJournal]

A 72-year-old man presented to the emergency department with fever, meningismus, and focal neurologic deficits, after 5 days of fatigue, malaise, headache, and encephalopathy. Read more: https://t.co/OIpa3oRqYN
#NeuroTwitter #Meningoencephalitis

[Neurology Journal @GreenJournal]

Acute Hemorrhagic Leucoencephalitis: A Rare CNS Complication of Abrus precatorius Poisoning
https://t.co/08S4WyVw8V

#NeuroX

[JAMA Neurology @JAMANeuro]

Case report: a man who tested positive for IgLON5-IgG antibody after intermittent episodes of paresthetic feeling involving the throat and jaw.

https://t.co/BfT8ao0BXH

[Neurology Journal @GreenJournal]

A 64-year-old woman presented with 18 months of progressive scalp-neck dysesthesias, left leg weakness, and urinary urgency. Read more: https://t.co/vRflrr2ECL
#NeuroTwitter #NeuroX

[AJNR @TheAJNR]

#AJNRcow >> October 24, 2024 >> A 54-year-old man presents with history of episodic loss of consciousness for the last 6 months. There are no focal neurologic deficits and bilateral mild to moderate sensorineural hearing loss. View the case https://t.co/R3Cmr4zwHd.

[Adrian Budhram @adrianbudhram1]

CSF correction factors to determine the "true" WBC count after a traumatic LP: How well do they actually work? We examine their clinical utility, and highlight that corrected CSF WBC counts suggesting only mild pleocytosis merit cautious interpretation:

https://t.co/CYs9T7N4ZE

[Neurology Journal @GreenJournal]

Teaching Video NeuroImage: The “Chameleon Eyes Sign” in Myasthenia Gravis
https://t.co/GGNGHJS5GM

#NeurologyRF

[Continuum: Lifelong Learning in Neurology @ContinuumAAN]

Key Point 1 from the article NMOSD and MOGAD by Dr. Elia Sechi from the August Autoimmune Neurology issue, which is available to all at https://t.co/xsZ7Ob3nKu. @EliaSechi
#Neurology #NeuroTwitter #MedEd