Richard Serrano

👨🏽‍⚕️Médico Cirujano - UDO / Bolívar.
🩺Médico Internista - UCV.
🧠Neurólogo - UCV.
📈Electromiografía.
〰️ Electroencefalografía.

[Neurology Journal @GreenJournal]

Comparative Study of Sporadic and Immune Checkpoint Inhibitor–Related Forms of Myasthenia Gravis-Myositis Overlap Syndrome: https://t.co/leLOQb4mev

[Medicina Interna HCSBA @MHcsba]

JAMA 2026: Dolor lumbar
doi:10.1001/jama.2026.9631
#MedEd #MedTwitter #MedX
https://t.co/cL7saZNryb

[Neuroanato 2.0 @Cuneatos]

🧠

[Brain @Brain1878]

The skull–meningeal axis: a new window into multiple sclerosis progression

New scientific commentary by Tobias Granberg https://t.co/OC2dWCRUMm

[JAMA @JAMA_current]

Brief, positionally triggered vertigo with transient nystagmus on the Dix-Hallpike test is characteristic of #BPPV, a common and treatable cause of dizziness.

📊 Learn more in this JAMA Insights. https://t.co/WesWZtEjD2

[Txarito👹 @Rochita08c]

El núcleo espinal del trigémino tiene capas

[Neuroanato 2.0 @Cuneatos]

En aros de cebolla. 🧅

[Fred Lepore @FredLepore]

Can't take a HINT?
Try other ways to test vestibulopathy- macro/micro (during direct ophthalmoscopy) nystagmus, 20D frenzel lens-than searching for a catch-up saccade w/HINTS
but Skew confirms brainstem CVA(Dejerine 1914) dx if MG,TED,CNIV,decomp phoria,sagging eye,OTR are r/o'd

[Marcos Gamboa @mrcsgmb84]

¿ Hipotensión Ortostática en los pacientes crónicos y pluripatológicos ? 🩺
No se trata de "subir la presión", sino de prevenir caídas y mejorar síntomas. Gracias por compartir @FormigaFrancesc 👇🧵
doi:10.1001/jamainternmed.2026.0284
@IcyfaSemi @GT_Pluri_SEMI @semeg_es @seggeriatria @SEFRAOS_ @SENefrologia @SLANH_ @PerlaZambrano @FaustoHerediaDr @tavonavarro

[JAMA Neurology @JAMANeuro]

Peripheral neuropathy involves nerve damage that can cause numbness, tingling, pain, and mild muscle weakness in the legs and, sometimes, the arms.

📄 Learn more in this JAMA Patient Page.

https://t.co/0muI37vkwo

[Lea Alhilali, MD @teachplaygrub]

Feeling unarmed when it comes to evaluating cervical radiculopathy & foraminal narrowing on MR?

Think of the nerve root like a hot dog, sitting between the two buns of the disc/uncovertebral joint & facet.

The more you put in your hot dog, the more the hot dog itself is squished. Same w/the nerve root.

Spurring & degenerative change are like the extra topping that push on the hot dog inside the buns.

A small amount of toppings/degenerative change, leaves the hot dog space. But if you pile on fixings, then the hot dog is taken over.

Ask yourself--how is my hot dog doing?

Mild stenosis is like just a little ketchup & mustard on the bun but hot dog still has space.

Moderate stenosis is when you aren’t just putting on sauce, you are adding things that take up space, like relish.

But there’s only so much relish one can put on, so it doesn’t take up more than half the bun.

Severe stenosis is like a chili cheese dog, where the hot dog is smothered & it has no room in the bun away from the chili or cheese. Here the narrowing is greater than 50%

This is the Kim classification & has strong correlation w/symptoms I like it bc it doesn’t require calipers to estimate a >50% narrowing

So now you know how to both image and assess stenosis in the cervical neural foramen.

Now hopefully rating cervical foraminal narrowing won’t be a pain in the neck!

[Neurochecklists @neurochecklists]

We have just updated our IIHWOP checklist with this paper https://t.co/jCkXC3tJc2

[Neurochecklists @neurochecklists]

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

[Derek Griffin @DerekGriffin86]

Scapular pain is often the result of sensitized neck structures (radicular or otherwise). Even in the absence of arm symptoms.
https://t.co/vp7IkZn7RG

[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

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

痙攣重積を発症したCEA後の過灌流症候群の症例

脳血管自動調節能障害、血管原性浮腫のインパクトのある画像

[Brain @Brain1878]

Goh et al. find that the prognostic value of clinical indicators in MSA evolves over the disease course, with implications for clinical planning, patient counselling and future trial stratification. https://t.co/vq8WIrYdjX

[DrMansillaNeurologo @DrJPMansilla]

🧠 Esclerosis Múltiple (EM) en 2026: el paradigma cambió drásticamente. El objetivo terapéutico ya no es solo evitar recaídas clínicas.
Perlas de la actualización internacional en Neuroinmunología: ��🏻

[Carlos Moreno @CarlosJMoreno_]

#Review @TheLancet

Encephalitis.

Lancet 2026; 407: 1968–83