Hồ Quang Thịnh

[Shadi Yaghi @ShadiYaghi2]

Convexity SAH:
Differential diagnosis includes:
- Mycotic aneurysm
- ischemic stroke with conversion
- dural AVF
- Cerebral Amyloid Angiopathy
- trauma
- coagulopathy
- RCVS

Workup includes:
- CTA head and neck
- MRI/MRA brain w SWI
- possible angiogram

https://t.co/uDGH4XJB46

[脳神経外科医 堀 聡 Satoshi Hori @2aTkg86WMYicOGs]

内頚動脈閉塞に対する血栓回収における予後不良に関連する因子

・高齢
・ASPECTS
・NIHSS
・American Society of Interventional and Therapeutic Neuroradiology and Society of Interventional Radiology grade（側副血行路）
・血糖値

[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!

[World Stroke Academy @WorldStrokeEd]

#MondayTip
#Thrombophilia & Young #cryptogenic stroke Abnormalities are common early, but high-risk findings are rare
🤫SECRETO: 37.1%👉any abnormality; only 5.2% were high-risk
🧠Screen smarter: prior VTE, inactivity, low HDL-C or anemia may guide testing
https://t.co/vilb8MvS4u

[Neurochecklists @neurochecklists]

We have just updated one of our NPH treatment checklists with this paper https://t.co/DbAwZg6hnV

[Neurochecklists @neurochecklists]

We have just updated one of our MG in pregnancy checklists with this paper https://t.co/4dDNdXUl9t

[Neurochecklists @neurochecklists]

We have just updated our optic neuritis causes checklist with this paper https://t.co/EqziQIBkNs

[Neurochecklists @neurochecklists]

We have just updated our peri ictal MRI checklist with this paper https://t.co/lDj1SzK5yL

[DrMansillaNeurologo @DrJPMansilla]

🧠 Mitos vs. Evidencia en Esclerosis Múltiple (EM). Perlas clínicas en neuroinmunología para la consulta:

[Neurochecklists @neurochecklists]

We have just updated our MS CSF analysis checklist with this paper https://t.co/WBHcmud0ou

[sikandar adwani @SikandarAdwani]

Most temporal lobe seizures are not localised by one symptom in OPD.

Not by déjà vu.
Not by lip smacking.
Not by one abnormal EEG line.

They are localised by watching the seizure movie in order.

Think of TLE as a subway map.

Station 1: Aura Gate
Ask: what happened first?

Rising epigastric sensation, fear, déjà vu, smell or taste aura
Think mesial temporal.

Auditory buzzing, ringing, vertigo, sound in one ear
Think lateral temporal.

Station 2: Consciousness Station
When did the patient stop responding?

Temporal seizures often build gradually and leave confusion behind.
Absence is brief.
Frontal can be abrupt and dramatic.
Tempo matters.

Station 3: Automatism Junction

The mouth says temporal.
The hands may tell the side.
Lip smacking, chewing, swallowing
Temporal network.

Manual automatisms
Often ipsilateral.

Dystonic stiff arm
Contralateral.

One OPD question can be gold:
Which hand was fumbling, and which arm became stiff?

Station 4: Lateralisation Signal Box

Dystonia, clonus, forced version
Opposite hemisphere.

Postictal nose wipe
Same side.

Aphasia or postictal dysphasia
Dominant hemisphere.

Ictal speech or vomiting
Often non-dominant, but interpret with caution.

Station 5: Temporal-Plus Trap Exit
Some seizures only look temporal.

Think insula, operculum, orbitofrontal or TPO network when there is:
throat tightness
painful aura
perioral sensory symptoms
early hypermotor behaviour
discordant MRI, EEG and semiology
failed temporal surgery

The temporal lobe may be the platform.
The train may have entered from another line.

OPD rule worth saving:

Localise TLE by the movie:

First symptom

tempo

automatisms
lateralising signs

postictal language
EEG/MRI concordance

Not one sign.
The whole seizure sequence. #Neurotwitter #Medtwitter #TLE

[AJNR @TheAJNR]

Subarachnoid hemorrhage patterns on CT and MRI: Watch our Trainee Corner video at https://t.co/bFDS9cRYHP to learn about this and more:
https://t.co/sqEmJAvb8m

[Jacky Ganguly @JackyGanguly]

▶️Peripheral Neuropathy in Parkinsonism: PRKN, DJ1, PINK1, GBA, ATP13A2, etc
▶️Parkinsonism in Peripheral neuropathy: FIG4, LRSAM1, SLC25A46, DNAJB2, AARS, etc @kailashbhatia @MDCP_Journal #neurotwitter
https://t.co/gydN847oLY

[Nat Rev Neurology @NatRevNeurol]

New online! Rethinking prognosis in multiple sclerosis: a multiaxial perspective https://t.co/U4Dadj9nWe

[Aravind Palraj @Rheumat_Aravind]

Sjögren’s disease autoantibodies are clinically predictive — not just diagnostic.

• Anti-SSA/Ro → hallmark antibody
• Isolated anti-SSB has poor specificity
• RF → B-cell hyperactivity
• Low C4 → vasculitis/lymphoma risk

Serology often predicts phenotype, severity & prognosis.

#Rheumatology #Sjogrens #Immunology #MedEd

[NeuroLohman @KrizLohman]

🧠Vía Espinotalámica - Dolor, temperatura, tacto crudo
✅Terminaciones libres
✅Fibras Aδ y C
✅Asta Dorsal - Lamina 1
✅Decusa - Comisura Anterior, 2-3 segmentos ⬆️
✅Haz Espinotalámico Ant. y Lat.
✅N. Ventral Posterolateral - Tálamo
✅Corteza Somatosensorial Primaria

[World Stroke Academy @WorldStrokeEd]

#MondaytTip
#Malignant MCA stroke is a neurosurgical emergency...
☝️but DHC is not just a technical decision
📉It reduces mortality, often with major disability

🔍Recognise early
👥discuss within 48h
🎯and centre patient values

From: https://t.co/sTXhjaedGC

[Sultan @Sultan__Shehri]

This week is peripheral neuropathy awareness week so here are a few useful articles about PN

Ten steps in diagnosing PN
https://t.co/sYjpAhUqjI

The 10 P's
https://t.co/tV6tdqueLX

PN JAMA Review
https://t.co/dsQKfG5oRl

Tests for treatable small-fiber PN
https://t.co/xcNlgFNaXf

[XRP Ledger Announces @XRPL__A]

Bilateral high stepping gait with a high knee lift in a case of chronic inflammatory neuropathy

[The Lancet @TheLancet]

Presented today at #ESOC2026: Ticagrelor with aspirin dual antiplatelet therapy combined with intravenous thrombolysis in patients with ischaemic stroke in China (TAPIS): a multicentre, double-blind, randomised controlled trial

🔗 https://t.co/4bJgEw8jek @ESOstroke