Jason James Ramcharan

MD. Neurologist

[Sayed S Rahman @SayedSRahman1]

Rituximab Protocol :
Before considering Rtx we should ask ourselves 4 questions :
1️⃣ Have we screened for HBV ?
2️⃣ Have we thought about TB?
3️⃣ Are vaccinations up to date?
4️⃣ Is there an active infection hiding somewhere ?

#Rituximab

[Dr sthanu subramanian @drsthanus]

Trimethoprim-sulfamethoxazole (TMP-SMX) and Aseptic Meningitis.

Drug-Induced Aseptic Meningitis (DIAM), a rare but well-documented adverse reaction to the antibiotic. Trimethoprim-sulfamethoxazole (TMP-SMX) is one of the most frequently implicated antibiotics in this condition.

This condition develops via the following mechanisms and clinical signs:

1. Hypersensitivity Reaction:

The exact cause is an immune-mediated reaction rather than a live infection.

The patient's immune system overreacts to the drug, leading to inflammation in the meninges.

2. Blood-Brain Barrier Penetration:

Because TMP-SMX crosses the blood-brain barrier, this inflammatory response can occur directly within the central nervous system.

3. Negative Cultures:

Because the symptoms are driven by an immune response—not bacteria or fungi—cerebrospinal fluid (CSF) cultures and gram stains will come back negative.

4. Rapid Reversal:

The diagnosis is often confirmed retrospectively; symptoms rapidly improve within 24 to 72 hours after the medication is discontinued.

●Potential causes of drug-induced aseptic meningitis

https://t.co/8lDptd9I4y

[MedicoNotes @MedicoNotes]

🧠 7 STROKE SYNDROMES

Know the Syndrome → Find the Artery.

⸻

1️⃣ MCA Stroke

📍 Lateral hemisphere

🔹 Face & arm weakness > leg
🔹 Hemisensory loss
🔹 Homonymous hemianopia
🔹 Aphasia (dominant)
🔹 Neglect (non-dominant)

💎 Face & Arm > Leg = MCA

⸻

2️⃣ ACA Stroke

📍 Medial frontal/parietal lobe

🔹 Leg weakness > arm
🔹 Leg sensory loss
🔹 Abulia
🔹 Urinary incontinence

💎 Leg > Arm = ACA

⸻

3️⃣ PCA Stroke

📍 Occipital lobe

🔹 Homonymous hemianopia
🔹 Visual agnosia
🔹 Alexia without agraphia
🔹 Memory impairment

💎 PCA = Vision Problems

⸻

4️⃣ Lateral Medullary (Wallenberg)

📍 PICA occlusion

🔹 Vertigo & nystagmus
🔹 Dysphagia & hoarseness
🔹 Ipsilateral facial pain loss
🔹 Contralateral body pain loss
🔹 Ataxia

💎 Don’t Pick Up Candy
➡️ PICA → Dysphagia

⸻

5️⃣ Medial Medullary Syndrome

📍 Anterior spinal artery

🔹 Tongue deviates to lesion
🔹 Contralateral weakness
🔹 Loss of vibration/proprioception

💎 “12-Weak-Touch”
➡️ CN XII + Weakness + Touch loss

⸻

6️⃣ Lacunar Stroke

📍 Small penetrating arteries

🔹 Pure motor stroke
🔹 Pure sensory stroke
🔹 Ataxic hemiparesis
🔹 Dysarthria-clumsy hand

💎 No cortical signs

⸻

7️⃣ Basilar Artery Occlusion

📍 Brainstem infarction

🔹 Altered consciousness
🔹 Quadriparesis
🔹 Vertical gaze palsy
🔹 Dysarthria
🔹 Locked-in syndrome

💎 Basilar = Brainstem Emergency

⸻

📚 Master Neurology the High-Yield Way with the MedicoNotes Neurology Book.

🌐 Visit our website: https://t.co/2UQyCbb6in

[Jason James Ramcharan @JamesRamcharan]

#RamcharanNeuroCareClinic
#Neurology #Guyana

[Aravind Palraj @Rheumat_Aravind]

🧠 Not every inflammatory CNS lesion is MS.

When you see:
• Pachymeningitis
• Cranial neuropathies
• Long-segment myelitis
• Steroid-responsive CNS disease
• Basal meningeal enhancement

Think beyond demyelination.

Key neuro-rheumatology mimics:
🔹 Neurosarcoidosis
🔹 IgG4-related disease
🔹 Sjögren disease
🔹 Seronegative inflammatory CNS disorders
🔹 Chronic inflammatory hypertrophic pachymeningitis

MRI + systemic clues + PET-CT + biopsy often reveal the answer.

#Rheumatology #Neurology @docakx @IhabFathiSulima @DocPriyamMD @DrNikhilMD @Drkhenaizan #Neuroimmunology #MedTwitter #FOAMed #MedEd #Pachymeningitis #CNSInflammation

[Manual Of Medicine @ManualOMedicine]

Stroke Symptoms by Vascular Territory

#medtwitter #foamed #usmle

[Sociedad de Medicina de Emergencias de la Laguna @SOMELaguna]

🧠🫀Anticoagulación Temprana en Stroke Isquémico Agudo con Fibrilación Auricular

🔰📚Journal of Stroke 2026

https://t.co/4djKzQeqlJ

Enlace a Articulo Completo👇🏻🆓✅
https://t.co/rPEDXf5xvO

[Autoinmunes Medicina Interna Parc Taulí @autoinMI_tauli]

Inflammatory Myopathies. NEJM

⏩5 major subtypes show distinct muscle, skin, lung, and systemic involvement.
⏩Myositis-specific autoantibodies now guide diagnosis, prognosis, and personalized treatment strategies.
⏩New targeted therapies

https://t.co/UFiGMvtQgk

[Stanford Medicine 25 @StanfordMed25]

A stroke in the internal capsule produces a distinctive clinical picture, specific enough that a physician can often localize the lesion on exam alone. #StanfordMed25's guide walks through the related anatomy & exam findings: https://t.co/jsY9CmKsNb #StrokeAwarenessMonth

[Dr RP Singh, MD @rpsingh1894]

🧬 Muscular dystrophies are not just muscle diseases — they are progressive genetic disorders affecting mobility, respiration, the heart, and quality of life.

Recognize the high-yield clues:
🔹 Gowers’ sign → DMD
🔹 Myotonia → Myotonic dystrophy
🔹 Winged scapula → FSHD
🔹 Early contractures + arrhythmias → Emery-Dreifuss MD

Early diagnosis, genetic testing & multidisciplinary care can significantly improve outcomes. ❤️

#MuscularDystrophy #DMD #Neurology #MedTwitter #MedicalEducation #FOAMed #Genetics #MedicineMadeEasy

[Internal Medicine @pgMedicine]

Meningitis

[RADIOLOGISTS @DrAyubaD]

Repost this useful notes

[Internal Medicine @pgMedicine]

Peripheral neuropathy

[RADIOLOGISTS @DrAyubaD]

Common lesions (including tumors) on FLAIR MRI.

A time saver I wish I knew earlier(for residents and medical students)

Press like so everyone sees this ❤️. #MedX

[XRP Ledger Announces @XRPL__A]

MuSK myasthenia and the furrowed tongue

[Lea Alhilali, MD @teachplaygrub]

Just because it’s called SMALL vessel disease doesn’t mean it doesn’t have a BIG impact!

Small vessel disease (SVD) is a BIG contributor to vascular dementia, along w/large vessel cortical infarcts

Do YOU know all the faces of small vessel disease?

Common imaging markers of SVD include:

--White matter hyperintensities (WMHs)
--Lacunes
--Enlarged perivascular spaces
--Microbleeds
--Small subcortical infarcts
--Brain atrophy

But what you see isn’t always what you get!

Even in patients w/similar degrees of SVD, clinical symptoms can be very variable.

Variability exists because of:
--Perilesional penumbra
--Remote effects from disruption of brain connectivity
--Differing brain reserve & compensatory mechanisms

So remember, imaging findings of SMALL vessel disease are just the tip of a very BIG iceberg

[Oren Gottfried, MD @OGdukeneurosurg]

Brain parts

[World Health Organization (WHO) @WHO]

Follow these steps to help keep antibiotics effective for everyone:

✅ Only take antibiotics prescribed for you
✅ Ask if the prescribed antibiotics are the preferred first-line treatment
✅ Prevent infections by washing your hands and getting vaccinated

#AntimicrobialResistance

[The Cybersmile Foundation @CybersmileHQ]

Note to self…

[Oren Gottfried, MD @OGdukeneurosurg]

Spine issues @PTFlashcards