Neil RJ Watson

Neurology registrar in Edinburgh 🧠

- Into disorders of how we think and move, infection, education, data viz & illustration 🤔 👋 🏃 🧫 📚 📊 🖌

[Neil RJ Watson @NeilRJWatson1]

@BucklandTom @smead2 The difference is CWD is 100% free range / sporadic, unlike BSE (man-made issue) so very different contain. Freely excreted and remains in soil after animals die. Plus concerns that it could pass via an intermediate host and expand transmissibility onto other species - ominous.

[Neil RJ Watson @NeilRJWatson1]

Europe has 1/3 of global measles cases, and >40% are children under 5.

Huge significance to neurologists who will see devastating acute and delayed 'brain' consequences of this.

https://t.co/cR26oQM0Ia

#infection #vaccine #neurology #publichealth #measles

[Neil RJ Watson @NeilRJWatson1]

We live in a remarkable age. 5y OLE of patisiran vs placebo (APOLLO) for hATTR with polyneuropathy.

[JAMA Neurology @JAMANeuro]

In patients with hereditary transthyretin amyloidosis with polyneuropathy, treatment with patisiran resulted in better outcomes and survival than those receiving placebo. https://t.co/UEAueDVJfZ

[Prof Tom Solomon CBE @RunningMadProf]

It does not have to be fancy to be effective!

We have been studying patients with brain infections such as encephalitis and meningitis for decades. We have developed novel diagnostic tests, and worked on new treatments, but sometimes it’s the relatively simple things that can have the greatest impact.

Our brilliant research Fellow @b5ingh has led an amazing programme over the past five years looking at the early management of brain infections, and trying to understand where it goes wrong, so that we could develop a package of interventions to improve things.

And it’s actually worked!

With hospital stakeholders, policy makers, and patient and public representatives, we co-designed a multifaceted clinical and laboratory intervention, informed by an evaluation of routine practice. The intervention, tailored for each setting, included a diagnostic and management algorithm, a lumbar puncture pack, a testing panel, and staff training.

The study took place in hospitals across India, Malawi, and Brazil.

We found the percentage of patients getting the correct diagnosis increased, they got on the right treatment quicker and there were improvements in functional outcome measures.

Importantly, because we involved policy makers right from the start, and only used interventions which they said they could afford to maintain if they proved effective, these are sustainable interventions which are now being used every day.

And what’s really exciting is that the intervention is already feeding into national practice guidelines and WHO meningitis and encephalitis initiatives, to be scaled up globally.

Here’s a little video which tells you a bit more:
https://t.co/D6e6PyGfvU

And here is the paper just published in the Lancet for those who want to read more.

https://t.co/jz9TKAEaZ4

[Neil RJ Watson @NeilRJWatson1]

MDS protocol for NPH workup. Key points including:
- averaging multiple 10m walk trials
- post-LP tests at 3h, 24h and 48h
- 40-50mL tap desirable
- 25% improvement is key

...but first: would the patient actually want / be eligible for surgery? (Easily overlooked!)

#neurology

[Alissa Higinbotham, MD @AlissaHigMD]

Check out the MDS NPH Study Group's protocol to standardize the tap test in the workup of #nph including clinical & research considerations!
#MovementDisorders #MedEd #Neurology #NeuroX #NeuroTwitter #MedX @acostalmd @AlbertoEspay @DrAlfonsoFasano @iavilesolmos @PhilipTiptonMD

[Neurology Journal @GreenJournal]

A 26-year-old woman from northeastern India with no significant medical history presented with a 1-week history of moderate-to-severe holocephalic headache associated with vomiting & significant weight loss of 4 kg over 6 months. Read more: https://t.co/VHaPKlkKJB

#NeurologyRF

[Neil RJ Watson @NeilRJWatson1]

Encephalitis isn't as rare as people think, and it's all too easily missed, or diagnosed too late - with awful consequences. I'm sadly aware of those both in my work life and outside of it.

#WorldEncephalitisDay #encephalitis

[ACNR - A journal of neurology & rehabilitation @ACNRjournal]

Today is World Encephalitis Day - the biggest day of the year for people whose lives have been affected by inflammation of the brain. Since its launch in 2014, World Encephalitis Day has reached 628 million people globally in an effort to raise awareness of encephalitis.
#Red4WED

[Neil RJ Watson @NeilRJWatson1]

...and before the grammar police attack my title: it'll look weird no matter what permutation you use. This one looked least bad to me!

https://t.co/6T0c5YpmdT

[Neil RJ Watson @NeilRJWatson1]

UK neurologists now dual-train in internal medicine. I wrote a short piece on my experiences: https://t.co/NeIzCOzsoq

It was great fun talking with neurologists from Aberdeen & the Highlands on my views, pros/cons, tips to make the most of it, and hear others' views!

[Neil RJ Watson @NeilRJWatson1]

In short: I believe we are good for IM and it for us. Neurology is prevalent in hospital patients, neuro patients have comorbidities we can't ignore, our skills are valuable, and we can learn lots from other specialists. But you have to not overstretch, and look after yourself.

[Neil RJ Watson @NeilRJWatson1]

Another example of β-amyloid behaving as a prion, manifesting decades after exposure...

[Neurology Journal @GreenJournal]

This case highlights the diagnostic approach and importance of thorough clinical evaluation of young patients with intracerebral hemorrhages.
https://t.co/D4nSxDi5cA

#NeurologyRF #NeuroTwitter

[Neil RJ Watson @NeilRJWatson1]

@DrArpan100 @PracticalNeurol Read your article the other day - terrific work! Always great to see some decent neuro-ID content 👏

[Neil RJ Watson @NeilRJWatson1]

@MichaelOkun @JAMANeuro I tend to think of it as another neurodegenerative prodrome - akin to in AD and PD etc but probably just shorter due to the faster disease evolution. It was pronounced and severe in variant CJD and pointed towards that entity as a clue (+ dysaesthesia) compared to sporadic.

[Neil RJ Watson @NeilRJWatson1]

@smead2 Had a PERM/DPPX-like stiff, jerky, encephalopathic case that ended up sCJD but it took a very late-stage MR to clinch it. This type of presentation can be difficult to distinguish...

[Foad Taghdiri @FTaghdiri]

1/11
Neurological complications post-transplant are very important for #neurohospitalists and 🧠#residents who see these consults in 🏥. These complications occur in 10-30% of organ and HSCT recipients!! While often multifactorial, immunosuppressants are major contributors.

[Casey Albin, MD @caseyalbin]

1/
A 75 yo man with MCI, newly diagnosed atrial fibrillation, and HTN presents with worsening confusion and blurry vision.

BP 186/98, HR 93 (irregular), RR 14.

BP is controlled and an MRI is obtained.
A #ContinuumCase

[Neil RJ Watson @NeilRJWatson1]

@OAERG1 @ThomasGaist Excellent talk and great to see what's possible with proper Danish registry data.

[Neil RJ Watson @NeilRJWatson1]

Even though I don't report scans this is great to read, including the psychology around staying credible as a radiologist and not overcalling!

[Lea Alhilali, MD @teachplaygrub]

1/Feeling lucky? Or feeling evidence based?

A thread about an evidence based approach to reading a pituitary MRI, using the Knosp score for cavernous sinus invasion.

[Doc Navarrow @DocNavarrow]

💡Brain sagging signs like reduced mamillo-pontine distance, ponto-mesencephalic and interpeduncular angles, and splenium drooping are key MRI findings in primary intracranial hypotension🗝️🔐
https://t.co/BFk3jVFCTx

[Neil RJ Watson @NeilRJWatson1]

Tenecteplase is non-inferior to alteplase in acute stroke <4·5 h from onset (ATTEST-2)
https://t.co/ph82pmA2xK