Angel

MSN, APRN, AGACNP-BC, SCRN. Neurovascular APRN at The Queen's Medical Center 🧠 Views are my own & do not reflect that of my employer.

[Oren Gottfried, MD @OGdukeneurosurg]

AUTOANTIBODIES in Rheumatology
@RheumOnePagers

[Isaac Lamb, MD @IsaacLamb01]

NEUROLOGICAL APPROACH TO DIZZINESS

Dizziness is one of the most common reasons for a neurology consult. The murky waters of the vestibular system are scary to us mere mortals. But having a framework provides a map to sail these choppy seas!

Thread below:

[Oren Gottfried, MD @OGdukeneurosurg]

Things to know before calling these consults

@DrBrittV

[Lea Alhilali, MD @teachplaygrub]

Trying to cover your bases when it comes basal ganglia region anatomy?

Need some core knowledge of the corpus striatum?

Want to be a boss when it comes to anatomy here?

Can you see the Boss Baby w/the puffy cheeks here?

Here's how this baby can help you w/this anatomy...

Deep brain anatomy in the coronal plane looks like a baby with puffy cheeks. This can help you remember the anatomy & function!

Here’s how:

➡️Cingulate gyrus:
🔸Looks like the baby’s hair. It’s a SINGLE tuft of hair for the CINGulate gyrus
🔸Cingulate gyrus is involved in processing painful emotions
🔸Remember: CINGulate is for things that SINGED you

➡️Corpus callosum:
🔸Looks like the evil boss baby eye brows
🔸It’s the crossing fibers so it’s what makes the baby look cross!

➡️Fornix:
🔸Looks like the baby’s nose
🔸Involved in memory
🔸Remember the NOSE KNOWS things and FORnix never FORgets

➡️Corpus striatum:
🔸Looks like the baby puffy cheeks
🔸Made up of many different structures
▶️Putamen: important for motor skills. PUT-amen help you PUT-one foot in front of the other
▶️Striatal bundles: important for learning actions w/a reward. STRIatal bundles make you want STRIVE for better
▶️Caudate: involved in associated learning. CAUdate helps you learn the CAUSES

➡️Claustrum:
🔸Looks like the baby’s ears
🔸Inhibits motor function, esp during sleep
🔸Remember Santa CLAUStrum only comes when we sleep

Hopefully now you have a deep knowledge of these deep brain structures!!

[Lea Alhilali, MD @teachplaygrub]

1/Correlate clinically!

It’s harder than you think in THALAMUS—where its size is small & but the clinical symptoms are large.

Here’s a thread to help you remember the main thalamic syndromes & their locations!

[Michael Kentris, DO @DrKentris]

One of the most challenging yet essential skills to develop in the practice of medicine is the ability to think

The book "How to Think Like a Neurologist" by @emeltzermd does a great job introducing some foundational principles of neurology

Here's a summary:

[Angel @AngelE____]

Our chief, Dr. Nakagawa, representing Hawai'i in his discussion on the FOXO3 longevity genotype 🧠 #ISC24

[Angel @AngelE____]

@caseyalbin brains over beans!

[Oren Gottfried, MD @OGdukeneurosurg]

Approach to Interpreting Chest X-Rays

[Lea Alhilali, MD @teachplaygrub]

1/If you aren’t cheating, you aren’t trying!

Are you looking at MRIs?

Feeling some confusion about the diffusion?

Feel impaired when it comes to the FLAIR?

Wish you could cheat a little?

Here’s a little cheat sheet on all the sequences you NEED to know for looking at MRIs!

➡️T1: It’s for anatomy, so brain structures reflect the same color as real life.

🔸So gray matter is gray on T1 & white matter is white on T1.

🔸It’s also for contrast. Contrast is taken up by masses making them light up & easier to see.

➡️T2: It’s the water sensitive sequence.

🔸What is pathologic water in the brain? Edema!

🔸Remember--everything bad in this world is trying to turn you back into what you came from—water!

➡️DWI: Diffusion detects stroke, which are bright on DWI.

🔸But anything that makes space tight in the brain can be bright on diffusion (cellular masses, pus under pressure, etc.)

➡️Gradient: Gradient is sensitive to metals.

🔸What’s the most important metal in body? Iron—bc iron is in blood.

🔸So gradient is our blood sensitive sequence

🌟So remember🌟

▶️T1 is for Anatomy & Contrast
▶️T2 is for Water & Edema
▶️DWI is for stroke
▶️Gradient is for blood

Hopefully, this will help you next time you have an MRI--who says cheaters never win? 😉

[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 on imaging, 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

[Andreas Charidimou MD, PhD @a_charidimou]

🩸🧠Treatable causes of intracerebral haemorrhage

⭕️ Several macrovascular disorders
🗝️Key features seen on brain MRI and/or CT
💡 Clues for diagnosis

via: @DiseasePrimers

#neurotwitter #NeuroTwitter #NeuroRad #MedTwitter #MedStudentTwitter #MedEd #EndNeurophobia #Neurology #Neurosurgery #RadEd #stroke #amyloidangiopathy #FOAMncc #WICH2023

[Lea Alhilali, MD @teachplaygrub]

1/Does your ability to remember temporal lobe anatomy seem, well, temporary?

Are you feeling temporally challenged when it comes to this complex region?

Here’s a thread to help you remember the structures of the temporal lobe!

[Moises Dominguez, MD @MoiseyWoisey]

1/Seeing static? This could be visual snow syndrome. Read along this purely educational thread to learn more about this neurological condition!

#visualsnowsyndrome #vs #VSS #disabilitytwitter #neurology #neurotwitternetwork #meded #migraine

[Thomas Lawson @TomLawsonNP]

ENRICH trial. Minimally invasive ICH evac. vs medical treatment. Utility weighted mRS better in surgical group, especially lobar (vs anterior basal ganglia) ich location. Better mortality & LOS with surgery #NCS2023

[Angel @AngelE____]

@HeraKamdar @DianaGCMD beautiful & smart ladies ❤️ 🧠

[Emily Porter, M.D. @dremilyportermd]

Said every emergency physician and neurologist who has cared for multiple people under age 40 with devastating strokes caused by vertebral artery dissection from rapid neck manipulation by chiropractors.

[Lea Alhilali, MD @teachplaygrub]

1/Having trouble remembering what you should look for in vascular dementia on imaging?

Almost everyone worked up for #dementia has infarcts. Which ones are important?

Here’s THE FULL #tweetorial this time on the key findings in vascular dementia
#meded #medtwitter #neurotwitter

[World Stroke Academy @WorldStrokeEd]

#MondayTip

#Basilar artery occlusions:

☝️Proximal/mid occlusions: atherothrombotic. Unilateral/crossed pontine syndromes to ‘‘locked-in’’
☝️Distal occlusions: most cardioembolic. Top of the basilar syndrome (dependins on length and position of the clot and on collateral flow)

[Ghada A Mohamed. @GhadaMohamedMD]

Hot off Press: a systematic review with meta-analysis more evidence that tissue clock matters beyond the time clock StrokeAHA_ASA⁩ ⁦@svinsociety⁩ ⁦@MuscNeurology⁩ ⁦@samialkasab⁩ ⁦@E_Almallouhi⁩ ⁦@aboulnourh⁩ https://t.co/XPoBb6dzdn