David Domínguez G

Neurology Resident at Universidad CES🧠💙

Médico | Universidad del Norte 🇨🇴

[David Domínguez G @davidando98]

Querido yo a los 16: Si lo lograste, eres R1 de Neurología🧠❤️🥹

[JAMA Neurology @JAMANeuro]

💬 Perspective from JAMA: Monoclonal antibodies for #AlzheimerDisease clear brain amyloid-β and modestly slow cognitive decline in early stages, supporting a causal role but with clinically limited impact and risk for imaging abnormalities.

https://t.co/QoUOoTgDeg

[Dr sthanu subramanian @drsthanus]

This chart compares Narcolepsy and Idiopathic Hypersomnia (IH), highlighting their clinical differences:

https://t.co/CrZ4Qd5lvB

[Mauricio Ambriz @AmbrizMau]

Fisiopatología de la encefalopatía hepática en la cirrosis:

Frontline Gastroenterology 2026;17:331-344.

[Neurology Journal @GreenJournal]

French NOMADMUS Cohort Overview: Landscape Evolution of AQP4+NMOSD and MOGAD From 2010 to 2024 https://t.co/hRU0AOpSEU

[Annals of Indian Academy of Neurology @AnnIndAcadNeur]

Pulvinar sign occurs due to calcium deposition in the posterior thalamus in Fabry's disease (FD) ~ 23% patients. Sylaja et al report extensive extrapulmonary calcification in FD highlighting more widespread alteration in cerebral hemodynamics. 10.4103/aian.AIAN_476_17 @neuro_ian

[Lea Alhilali, MD @teachplaygrub]

Tired of always speculating about MR spectroscopy?

If you've ever looked at an MR spectroscopy & thought: "I have no idea what I’m looking at!"--then this cheat sheet is for you!

Here are the 4 basic rules you need so you can understand the spectrum of basic spectroscopy!

First you need to know the peaks. 
3 main peaks: Choline, Creatine, NAA
Remember the order bc a spectrum looks like mountain peaks & it is cold in the mountains.  And CHOld CREATures NAp or hibernate in the mountains

Choline
Marker of membrane turnover
Remember: membranes coat or “CHOat” the cell
Choline = ChoLEAN, choline LEANS into the creatine peak, it’s right next to it

Creatine
Marker of energy, basically an internal control
Remember, everyone takes Creatine powder for energy!
Creatine is at ~3—creatine almost rhymes with 3

NAA
Marker of neuronal health
N = Neuron
NAA has double As so it is at ~2!

Four rules:

1. Hunter’s angle:
—Most people know that the peaks of the spectrum should go up at you move lateral, called Hunter’s angle
—Most bad things reverse Hunter’s angle
—Ask yourself: Is my arrow pointed up to shoot into the air at the enemy (good) or is point to the ground where it will hit the dirt (bad)

2. TE & spectrum length are inversely related
—Spectroscopy follows the rule: speak softly & carry a big stick. 
—Short TE = long spectrum, lots of extra peaks for glutamate/glycine, myoinsitol
—Long TE = short spectrum, mainly the basic 3 peaks

3. Each region has its own unique signature
—Each brain region has its own unique composition of compounds that might alter Hunter’s angle a bit, but not reverse it
—Need a control in contralateral normal brain so compare apples to apples

4. Lactate peak goes like a sine wave
—Lactate peak represents anerobic metabolism—sign of cells in trouble
It’s at 1.3ppm. Remember this bc 13 is an unlucky number & lactate is an unlucky sign!
—It’s like a sine wave: up at short TE (35), down at intermediate TE (144), and up again at long TE (244)
—You can use this flipping to better visualize the lactate peak
—You can remember it’s down in the middle TE bc when you’re caught in the middle, you’re down & out

Just remember these tricks & you will be spectacular at basic spectroscopy!

[Nat Rev Neurology @NatRevNeurol]

New online! Ten years of disease-modifying therapy in spinal muscular atrophy: lessons learned and future directions https://t.co/Ee46R3Axhw

[NEJM @NEJM]

𝗦𝘂𝗴𝗴𝗲𝘀𝘁𝗲𝗱 𝗥𝗲𝘃𝗲𝗿𝘀𝗮𝗹 𝗦𝘁𝗿𝗮𝘁𝗲𝗴𝗶𝗲𝘀 𝗼𝗳 𝗢𝗿𝗮𝗹 𝗔𝗻𝘁𝗶𝗰𝗼𝗮𝗴𝘂𝗹𝗮𝗻𝘁 𝗨𝘀𝗲 𝗳𝗼𝗿 𝗠𝗮𝗷𝗼𝗿 𝗕𝗹𝗲𝗲𝗱𝗶𝗻𝗴 𝗮𝗻𝗱 𝗯𝗲𝗳𝗼𝗿𝗲 𝗘𝗺𝗲𝗿𝗴𝗲𝗻𝗰𝘆 𝗦𝘂𝗿𝗴𝗲𝗿𝘆.

As shown in Panel A, reversal management depends on the urgency of surgery or the invasive procedure. Reversal management includes administration of oral or intravenous (IV) vitamin K with or without 4F-PCC, depending on the timing of the procedure (emergency or urgent), baseline international normalized ratio (INR) value, and presence (or absence) of active bleeding. For patients receiving direct oral anticoagulants (DOACs), the decision also depends on time to surgery. Decision making is informed by DOAC type, time since last dose, half-life, presence (or absence) of active bleeding, and renal function tests to estimate residual drug activity.

Panel B shows reversal strategies for patients presenting with major bleeding while receiving an oral anticoagulant. The reversal strategy of vitamin K antagonists includes vitamin K given intravenously or orally, combined with 4F-PCC and INR testing. Management of anticoagulant reversal of direct oral FXaIs is based on four key factors (shown as the 4Ts): type of bleeding, timing of the last dose, thrombotic risk, and need for invasive procedures in the next 48 hours that would result in the administration of UFH. These factors may facilitate the use of specific (e.g., andexanet alfa) or nonspecific (e.g., 4F-PCC) antidotes. The reversal of dabigatran is informed by three clinical variables (shown as the 3Rs) — the type of bleeding, time of the last dose of dabigatran, and preserved renal function.

Learn more in the Review Article “Antidotes for Anticoagulation Reversal” by Bianca Rocca, MD, PhD, and Hugo ten Cate, MD, PhD: https://t.co/XobqwMebfy

NEJM subscribers: Explore this article deeper with AI Companion.

[1-min ID consult @1min_IDconsult]

【Voriconazole: Ocular and neurological effects】

Frequent visual disturbance/hallucination should be fully explained before starting voriconazole!

Level: Intermediate to Advanced

#IDMedEd #IDFellow #TxID

[Gabriel Puche, MD/PhD @gabi_puchepalao]

🧠 ¿Pensando en un paciente joven con ictus o demencia incipiente?

No olvides el CADASIL, la causa genética más común de ictus isquémico en adultos jóvenes.

👉Es una angiopatía NO aterosclerótica y amiloide-negativa que destruye el pequeño vaso. 🧵👇

[Nirmal Pandey MD DM Neurologist @nirmalregency]

Not all optochiasmatic arachnoiditis lesions are paradoxical reactions, many of them may be primary TB granulomatous lesions.
https://t.co/rl1Zt5FLyl

[TheDaoIndex @KDAO2011]

#EULAR2026 reccs on classification criteria for antisynthetase syndrome @RheumNow

[Lea Alhilali, MD @teachplaygrub]

Listen up!

Trying to get into a rhythm on how to approach pulsatile tinnitus?

Does pulsatile tinnitus get your heart racing?

This week’s @theAJNR SCANtastic has all you need to know!

https://t.co/BTI94N5Wsk

Pulsatile tinnitus is caused by turbulent blood around the petrous bone!
It’s like traffic: if you alter the flow of traffic, you will start to hear some noise & horns!

So what causes turbulent traffic?
1. Complex traffic patterns
If the roads are crazy, people get confused and drive crazy. Same w/flow from:
--AVMs
--dAVFs
--Tumors
--Diverticula

2. Diverted traffic
Nothing causes more chaos than making people go a different way than normal. Variant flow anatomy can cause pulsatile tinnitus:
--Large mastoid emissary veins
--Large occipital sinus. 

3. Blockage of traffic!
If there is an accident, there is turbulence as people try to get around. For flow, blockages are stenoses:
--Carotid stenosis
--Transverse/sigmoid sinus stenosis
--Jugular stenosis

In this month’s @theAJNR, Zhang et al. found jugular stenoses were equally prevalent in both controls & pts w/pulsatile tinnitus

It raises the question if should we treat jugular stenosis!

Now hopefully your heart won’t skip a beat when you see a case of pulsatile tinnitus!

Follow @theAJNR and check it out for yourself:

https://t.co/BTI94N5Wsk

[NEJM @NEJM]

Original Article: Obexelimab for the Treatment of IgG4-Related Disease (phase 3 INDIGO trial results) https://t.co/UP3IT4HLMN

Editorial: Obexelimab and the Promise of Nondepleting B-Cell Therapy in IgG4-Related Disease https://t.co/Km4LndkI5z

#EULAR2026 | @eular_org

[Oliverio @LuisOliverio]

Mucha Neurología por leer. Nuevo Número de Continuum con:

🔵 Prevención de EVC
🔵 Embarazo y riesgo de EVC
🔵 Trombolisis, trombectomía y antitrombóticos
🔵 EVC en niños y adolescentes
🔵 Hemorragia intracerebral
🔵 Ateroesclerosis de grandes arterias
🔵 Malformación arteriovenosas (MAV) y aneurismas intracraneales

Y una revisión de Alzheimer en The Lancet.

[Jacky Ganguly @JackyGanguly]

Landscape of Pediatric Immune-mediated Movement disorders: Autoimmune Vs Autoinflammatory disorders @puneet3042 @sayoniroychowd1 #AOMD #neurotwitter
https://t.co/bKUps40TMB

[Jacky Ganguly @JackyGanguly]

Genetic Prion diseases @smead2 @TheLancetNeuro
- Not to miss Diarrhoea-Dysautonomia phenotype
#neurotwitter

[Andreu Vilaseca @andreuvilaseca7]

Congrats on this prospective study in @GreenJournal!
Beyond the striking finding that nearly half of rapidly progressive dementia etiologies were immune-mediated, it is a great example of how neurologists can generate meaningful data while doing clinical work👏🏽
Example to follow!

[Journal of Neurology, Neurosurgery and Psychiatry @JNNP_BMJ]

Lecanemab appropriate use recommendations for clinical practice in the UK
https://t.co/yrGTtFk3Fv