Ade Wijaya

[Ade Wijaya @awesome_dream]

This effect can also caused by interaction with other drugs such as enzyme inhibitor (valproic acid) —> increasing free phenytoin level in circulation

[Ade Wijaya @awesome_dream]

Chronic use of phenytoin especially in higher dose can cause toxicity to cerebellum (cerebellar atrophy). It may lead to ataxia. This condition could be irreversible, so awareness is important!

[Ade Wijaya @awesome_dream]

Have u ever experienced shoulder pain after laparoscopy surgery / sectio caesaria? It’s called a shoulder tip pain.
A kind of referred pain caused by distention of diapraghm by the gas used during procedure. Because of same innervation of phrenic nerve that originated from C3-5

[Ade Wijaya @awesome_dream]

Gabapentinoids, friends or foes? They are widely used (overused) for many clinical conditions esp. neuropathic pain.

However, they also have many (-) effects that often overlooked.

Use wisely and be careful of they usages in elderly, concomintant use with opioid or benzo

[Ade Wijaya @awesome_dream]

Female 46yo presented with acute dizziness, slurred speech and tetraparesis. Brain MRI (done at 24 hours onset) were normal. No babinsky, biceps and patellar reflexes were normal.

Consider PCB variant of GBS as differential diagnosis.

Perform NCV studies and CSF analysis!

[Ade Wijaya @awesome_dream]

Ulnar entrapment edx tips!

Cubital Vs Trunk lesion
1. Medial Cutaneus Antebrachii sensory nerve
2. EDC & EIP EMG

If EDC & EIP muscle EMG and Medial Cutaneus Antebrachii Sensory nerve abnormal —> Inferior Trunk of Brachial Plexus Lesion

[Ade Wijaya @awesome_dream]

Ulnar entrapment edx tips!

Guyon vs Cubital
1. Dorsal cutaneus branch of ulnar nerve
2. EMG of FCU muscle

If FCU muscle EMG and dorsal cutaneus branch of ulnar nerve abnormal —> cubital tunnel syndrome

[Ade Wijaya @awesome_dream]

Sunflower syndrome: Rare form of photosensitive epilepsy in children provoked by bright sunlight exposure. The term sunflower comes from the distinctive behavior, turn their heads toward the sun & wave their fingers in front of their eyes to create flickering effect. 🌻

[Ade Wijaya @awesome_dream]

Progressive weakness and atrophy of distal upper limb muscles, primarily affecting young males. Consider Hirayama disease: A rare disease. Part of motor neuron disease with more benign and self-limiting nature.

[Ade Wijaya @awesome_dream]

Eye swelling after motor vehicle accident. Consider Carotid Cavernous Fistula (CCF). Diagnosis & Treatment: DSA, endovascular intervention.

[Ade Wijaya @awesome_dream]

In cases of unruptured intracranial aneurysm, Phases score and UIATS could help to assess whether intervention is needed.

[Ade Wijaya @awesome_dream]

Vestibular Paroxysmia is a vestibular form of “trigeminal neuralgia”. usually caused by compression of vestibular nerve by blood vessel resulting in reccurent vertigo (seconds-minutes) and often accompanied with tinnitus and triggered by movement. Treatment: anticonvulsants, MVD

[Ade Wijaya @awesome_dream]

Do you know that “laughing” can be a form of epileptic seizure?
It’s called as a gelastic seizure
Which often associated with hypothalamic hamartomas

[Ade Wijaya @awesome_dream]

Capsular warning syndrome is a rare spectrum of transient ischaemic attack that occurs very often in a short time (Crescendo TIA) - This condition has a high tendency to develop into a full-blown stroke.

[Ade Wijaya @awesome_dream]

Developmental Venous Anomaly or Venous Angioma often presents with seizures and headache
Consider it as differential diagnosis in patients with reccurent headache and seizures.

[Ade Wijaya @awesome_dream]

ME-CFS is a condition characterized by profound fatigue, sleep abnormalities, pain and other symptoms such as cognitive impairment / postural orthostatic syndrome that are made worse by exertion. This condition mostly affects ppl in productive age that may impairs QOL.

[Ade Wijaya @awesome_dream]

Antiseizure medications not only affecting hormones in female but also affecting hormones and sexuality in male. Lamotrigine is the better option related this issue compared to some traditional antiseizure medications such as carbamazepine and valproate.

[Ade Wijaya @awesome_dream]

Stroke with ipsilateral hemiparesis? Yes, it can happen in a syndrome called Opalsky, when the infarct occured at inferior part of medulla oblongata after the decussatio.

[Ade Wijaya @awesome_dream]

The syndrome of the trephined is a delayed complication of craniectomy, where patients experience neurological deterioration, including cognitive decline, motor dysfunction, and headache, after the surgery. Hallmark: Sinking skin flap.
Treatment: cranioplasty.

[Ade Wijaya @awesome_dream]

Embolization of meningeal medial artery is an alternative treatment option for chronic subdural hematoma in selected cases. This procedure can also be done in addition to burr hole procedure to prevent rebleeding.