Swalay

Nephro

[MedicoNotes @MedicoNotes]

🌀 7 CAUSES OF VERTIGO

Vertigo is a symptom, not a diagnosis.

When a patient complains of “dizziness,” the key question is:

❓ Is this true vertigo (a false sensation of movement) or something else?

Correctly distinguishing peripheral from central causes is essential, as some causes are benign, while others may represent a neurological emergency.

🔑 Common Causes of Vertigo

1️⃣ BPPV (Benign Paroxysmal Positional Vertigo)
• Most common cause
• Brief episodes triggered by head movement
• No hearing loss
• Positive Dix-Hallpike test
• Treated with the Epley manoeuvre

2️⃣ Vestibular Neuritis
• Acute severe vertigo lasting days
• Often follows a viral illness
• Nausea and vomiting common
• No hearing loss

3️⃣ Ménière Disease
• Recurrent episodes of vertigo
• Fluctuating hearing loss
• Tinnitus and aural fullness
• Usually unilateral

4️⃣ Vestibular Migraine
• Vertigo associated with migraine features
• Photophobia, phonophobia, aura
• May occur without headache

5️⃣ Labyrinthitis
• Vertigo + hearing loss
• Often post-viral
• Auditory and vestibular symptoms occur together

6️⃣ Acoustic Neuroma (Vestibular Schwannoma)
• Progressive unilateral hearing loss
• Tinnitus
• Gradual onset imbalance or vertigo

7️⃣ Central Causes 🚨
• Stroke
• Multiple sclerosis
• Cerebellar tumours
• Brainstem lesions

⚠️ Red Flags Suggesting a Central Cause

🚨 Diplopia
🚨 Dysarthria
🚨 Limb weakness
🚨 Severe ataxia
🚨 New headache
🚨 Persistent neurological deficits

🩺 Clinical Approach

✔️ Take a careful history
✔️ Examine for nystagmus
✔️ Perform the HINTS examination when appropriate
✔️ Assess hearing
✔️ Look for focal neurological signs

💡 High-Yield Pearl

Peripheral vertigo is common, but never miss a central cause.

Remember:

🧠 Acute vertigo + neurological signs = Stroke until proven otherwise.

📚 Save this post and visit our website for innovative high-yield medical notes:

https://t.co/Ivljom2bsM

#Vertigo #Neurology #BPPV #MeniereDisease #vestibularneuritis

[CardiovascularCorner @TrackYourHeart]

How long should anticoagulants be withheld before elective surgery?

◻️Apixaban: 1 day (low/moderate bleeding risk), 2 days (high risk)
◻️Rivaroxaban: 1 day (low/moderate), 2 days (high)
◻️Edoxaban: 1 day (low/moderate), 2 days (high)
◻️Dabigatran: 1-4 days depending on bleeding risk & renal function
◻️ Fondaparinux: 36-42 hours
◻️ LMWH: 12 h (prophylactic), 24 h (therapeutic)
◻️ UFH: IV 4-6 h; SC 12–24 h
◻️ Warfarin: Stop 5 days before surgery; confirm INR before the procedure.

Adjust timing for renal impairment, neuraxial anesthesia, and individual patient risk. Bridging is reserved for selected high-thrombotic-risk patients.

Reference: 2024 AHA/ACC Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery, Table 13.

[Dr Rupam Manna MD @DrRupamOncology]

Ifosfamide Chemotherapy Precautions 🧪
This infographic covers: • Preventing hemorrhagic cystitis — Mesna + vigorous hydration is the most important measure
• Ifosfamide-induced encephalopathy — risk factors, clinical features & methylene blue as antidote
• Renal monitoring for Fanconi syndrome, electrolyte wasting & metabolic acidosis
• Myelosuppression, G-CSF prophylaxis (especially with AI regimen), antiemetics & supportive care
• Complete baseline checklist before each cycle + fertility & pregnancy considerations
High-yield DrNB / Medical Oncology exam pearls included.
Save this for safe ifosfamide use in clinic & exam revision 👇
What’s one precaution you always double-check before starting ifosfamide in your practice?
#Ifosfamide #ChemotherapySafety #OncologyEducation #DrNB #MedicalOncology #MedEd #CancerConceptsExplained

[Amelia Carro — Instituto Corvilud @icorvilud]

UACR: urinary albumin to creatinine ratio
📌Gold standard tool to detect early kidney damage
🫀Cardiovascular risk indicator
⚠️Highly recommended:
. Diabetes
. Obesity
. High blood pressure
. CVD/CV risk
💊Can be targeted
. ARAII
. SGLT2i
. GLP1
. Finerenone
⚠️WHY SO UNDERUSED?

[🦠 Dr. Ahmed Alanazi @o_o_dr]

🧠 Subarachnoid Hemorrhage (SAH)

إذا قال المريض:

"أسوأ صداع في حياتي"

فتعامل معه على أنه SAH حتى يثبت العكس.

ابدأ بـ CT بدون صبغة، وإذا كانت النتيجة طبيعية وما زال الاشتباه مرتفعًا، فأكمل بـ Lumbar puncture أو CT angiography حسب الحالة.

💡 تذكّر:

السيطرة على ضغط الدم.

إعطاء Nimodipine للوقاية من Cerebral vasospasm.

التدخل المبكر لإغلاق الـ Aneurysm (Coiling أو Clipping) يقلل خطر إعادة النزيف ويحسن فرص النجاة.

#Neurology #SAH #EmergencyMedicine #InternalMedicine #SMLE #MedEd

[Abdelhamed Hamdy @Abdelhamed6261]

CKRT weaning

[Ahmed Ata @Ahmedata7777]

🩺 Subclavian Steal Syndrome (SSS)

Subclavian steal syndrome is a hemodynamic phenomenon caused by significant stenosis or occlusion of the proximal subclavian artery (before the origin of the vertebral artery).

Thread 👇

[CardiovascularCorner @TrackYourHeart]

Wide QRS Tachycardia
1️⃣ Ventricular tachycardia (VT)
2️⃣ SVT with aberrancy
3️⃣ SVT with preexcitation (WPW)
4️⃣ SVT with baseline abnormal ECG
5️⃣ SVT with hyperkalemia
6️⃣ Ventricular pacing

[Abdelhamed Hamdy @Abdelhamed6261]

What are the factors keeping bowman's space in the glomerulus opened and not collapsed
Is it the flow resistant induced by thin descending loop or other mechanisms

[Internal Medicine @pgMedicine]

Cardiovascular–kidney–metabolic syndrome links obesity, diabetes, chronic kidney disease, and cardiovascular disease into one connected framework. Understanding the stage helps you screen earlier, stratify risk better, and intervene before overt cardiovascular events develop

[Internal Medicine @pgMedicine]

Petechiae, Purpura & Ecchymosis

[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

⸻

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[Aravind Palraj @Rheumat_Aravind]

VASCULITIS MIMICS

Not every purpura is vasculitis.

Before labeling a patient as having primary vasculitis and initiating immunosuppression, consider important mimics such as infective endocarditis, cholesterol embolization syndrome, antiphospholipid syndrome, thrombotic microangiopathy, calciphylaxis, atrial myxoma, fibromuscular dysplasia, levamisole-associated vasculopathy, septic emboli, and malignancy-associated vasculitis-like syndromes.

Recognizing the red flags can prevent diagnostic errors, unnecessary immunosuppression, and potentially life-threatening consequences.

Which vasculitis mimic have you found most challenging in clinical practice?

Infographic by Dr. Aravind Palraj

#Rheumatology #Vasculitis #ANCA #MedicalEducation #MedEd #FOAMed #InternalMedicine #Nephrology #ClinicalReasoning @IhabFathiSulima @docakx #AutoimmuneDisease #MedTwitter #RheumTwitter #MedX #Medicine #MedEdCommunity

[Internal Medicine @pgMedicine]

ALL, AML, CML and CLL

[Abdelhamed Hamdy @Abdelhamed6261]

FIND CKD

[nervemed @nervemed]

Drugs to be avoided in Myasthenia Gravis.
Mnemonic: AB MCQ

[Aravind Palraj @Rheumat_Aravind]

Not every ANA-positive patient has lupus.

Many disorders can closely mimic SLE, including Sjögren disease, MCTD, drug-induced lupus, viral infections, adult-onset Still disease, ANCA-associated vasculitis, sarcoidosis, tuberculosis, infective endocarditis, and fibromyalgia.

Recognizing the clues against SLE is just as important as recognizing the clues for it.

Which lupus mimic has challenged you the most in practice?

#Rheumatology #Lupus #SLE #AutoimmuneDisease #MedEd #FOAMed #RheumTwitter #MedTwitter #ClinicalReasoning #InternalMedicine @IhabFathiSulima @docakx