Discover and read the best of Twitter Threads about #ContinuumCase
Most recents (11)
1/ #ContinuumCase!!
A 50 yo man presented to the ED with acute onset aphasia. He is not able to report a history, but BP Is 215/95.
Non-contrast HCT reveals this bleed…
What do you want to see next?
A 50 yo man presented to the ED with acute onset aphasia. He is not able to report a history, but BP Is 215/95.
Non-contrast HCT reveals this bleed…
What do you want to see next?
2/
What do you most want next?
What do you most want next?
3/
Cortical bleeds are IMHO way more fun than basal ganglia hemorrhages.
Even though BP was elevated, that is true of many patients who have non-hypertensive etiologies of their bleeds!
In these patients you must consider:
🩸CAA
🩸Endocarditis
🩸Atypical aneurysms
🩸RCVS....
Cortical bleeds are IMHO way more fun than basal ganglia hemorrhages.
Even though BP was elevated, that is true of many patients who have non-hypertensive etiologies of their bleeds!
In these patients you must consider:
🩸CAA
🩸Endocarditis
🩸Atypical aneurysms
🩸RCVS....
1/
🚨Code stroke to the Med-Surg floor!
53 yo M with hep C & IVDU admitted yesterday for fever & chills.
BCx=GPCs in clusters😨. An ECHO is planned.
He develops witnessed-onset R sided weakness & aphasia. Head CT👇
Do you push tPA?
A #continuumcase
🚨Code stroke to the Med-Surg floor!
53 yo M with hep C & IVDU admitted yesterday for fever & chills.
BCx=GPCs in clusters😨. An ECHO is planned.
He develops witnessed-onset R sided weakness & aphasia. Head CT👇
Do you push tPA?
A #continuumcase
2/
LSW <2 hours ago. Head CT with no ICH.
Do you push tPA?
LSW <2 hours ago. Head CT with no ICH.
Do you push tPA?
3/
Lets give a little more context. CPR is 43. CT A/P done the day prior demonstrates renal infarcts.
On your exam you find Janeway lesions.
What about now? tPA?
Lets give a little more context. CPR is 43. CT A/P done the day prior demonstrates renal infarcts.
On your exam you find Janeway lesions.
What about now? tPA?
1/
Back from #AANAM and missing the learning?
Enter #ContinuumCase
A 75-yo👩 presents to clinic.
- 1 month ago: monocular blurred vision in L👁️
- C U/S: 70% to 80% ICA stenosis
- On ASA 81 & Atorva 20mg; LDL 132 mg/dL b/f lipid therapy
How do you proceed?
[not her MRA]
Back from #AANAM and missing the learning?
Enter #ContinuumCase
A 75-yo👩 presents to clinic.
- 1 month ago: monocular blurred vision in L👁️
- C U/S: 70% to 80% ICA stenosis
- On ASA 81 & Atorva 20mg; LDL 132 mg/dL b/f lipid therapy
How do you proceed?
[not her MRA]
Next step in management, #neurotwitter?
3/
Management of a Hot Carotid (or, in this case, a chilled carotid) can get spicy 🌶️!
This is an area in neurology where we (actually!) have trial data, but things get complicated based on the patient's:
⚧️Gender
🔞Age
💊Medical risk factors
⏲️Timing from index ischemic event
Management of a Hot Carotid (or, in this case, a chilled carotid) can get spicy 🌶️!
This is an area in neurology where we (actually!) have trial data, but things get complicated based on the patient's:
⚧️Gender
🔞Age
💊Medical risk factors
⏲️Timing from index ischemic event
1/
#ContinuumCase
A 67 yo man with a known, active cancer presents to the ED. His wife reports that he has had worsening headaches, forgetfulness, & confusion. Today, he was increasingly sleepy which triggered the presentation.
An MRI is ordered.
🤔🤔🤔 @ContinuumAAN @LyellJ
#ContinuumCase
A 67 yo man with a known, active cancer presents to the ED. His wife reports that he has had worsening headaches, forgetfulness, & confusion. Today, he was increasingly sleepy which triggered the presentation.
An MRI is ordered.
🤔🤔🤔 @ContinuumAAN @LyellJ
2/
Neurologic complications in cancer patients are tricky. They can be due to
✨Malignant lesions
✨Systemic complications of disease
✨Paraneoplastic disorders
✨Treatment Side effects
Neurologic complications in cancer patients are tricky. They can be due to
✨Malignant lesions
✨Systemic complications of disease
✨Paraneoplastic disorders
✨Treatment Side effects
3/
You absolutely must have a systemic approach to these patients. I think the best framework for this is in this review by @holroyd_katie, Dan Rubin and Henrikas Vaitkevicius:
pubmed.ncbi.nlm.nih.gov/34619783/
You absolutely must have a systemic approach to these patients. I think the best framework for this is in this review by @holroyd_katie, Dan Rubin and Henrikas Vaitkevicius:
pubmed.ncbi.nlm.nih.gov/34619783/
1/
Just how much can ultrasonography reveal about the neurovascular health of the brain?
A whole freaking lot!!
A #ContinuumCase about a man with transient dizziness after doing heavy lifting in the yard. @ContinuumAAN @LyellJ
Just how much can ultrasonography reveal about the neurovascular health of the brain?
A whole freaking lot!!
A #ContinuumCase about a man with transient dizziness after doing heavy lifting in the yard. @ContinuumAAN @LyellJ
2/
There are a lot of way this case could unfold…
Was he just dehydrated?
Did he have a dissection?
Have a PE?
But with more questions, it becomes clear that this has happened before.
Whenever he is doing heavy lifting, his left arm becomes tingly & then the room spins 🤔
There are a lot of way this case could unfold…
Was he just dehydrated?
Did he have a dissection?
Have a PE?
But with more questions, it becomes clear that this has happened before.
Whenever he is doing heavy lifting, his left arm becomes tingly & then the room spins 🤔
3/
#NeuroTwitter, what's going on?
#NeuroTwitter, what's going on?
1/
A 59 year old woman presents with acute onset 10/10 headache (⛈️) and radiating occipital pain.
Non-con head CT is performed and reveals this👇
#problem
But the CTA shows no aneurysm.
So... now what?
A #ContinuumCase.
A 59 year old woman presents with acute onset 10/10 headache (⛈️) and radiating occipital pain.
Non-con head CT is performed and reveals this👇
#problem
But the CTA shows no aneurysm.
So... now what?
A #ContinuumCase.
2/
The most feared cause of subarachnoid hemorrhage is aneurysm rupture, but it’s super important to remember that not all SAH is aneurysmal.
Before jumping to any conclusion. It’s critical to assess the pattern of SAH:
The most feared cause of subarachnoid hemorrhage is aneurysm rupture, but it’s super important to remember that not all SAH is aneurysmal.
Before jumping to any conclusion. It’s critical to assess the pattern of SAH:
3/
Cortical SAH is rarely related to aneurysm unless it’s a mycotic aneurysm. Cortical SAH is much more likely to fall into one of these diagnoses:
Cortical SAH is rarely related to aneurysm unless it’s a mycotic aneurysm. Cortical SAH is much more likely to fall into one of these diagnoses:
#ContinuumCase, plot twist edition:
A 28 year old PGY2 neurology resident is asked by her attending to review 2 scans and determine the diagnosis: Alzheimer disease (AD) or dementia with Lewy bodies (DLB).
What should she say, #neurotwitter?🧵
A 28 year old PGY2 neurology resident is asked by her attending to review 2 scans and determine the diagnosis: Alzheimer disease (AD) or dementia with Lewy bodies (DLB).
What should she say, #neurotwitter?🧵
How would you respond?
Her response:
“Dementia is a clinical diagnosis supported by imaging, CSF, and neuropathological biomarkers. But, the disproportionate hippocampal atrophy in Patient B supports a diagnosis of AD.”
“Dementia is a clinical diagnosis supported by imaging, CSF, and neuropathological biomarkers. But, the disproportionate hippocampal atrophy in Patient B supports a diagnosis of AD.”
1/
A #ContinuumCase to start the week off!
21 yo👨 w/ a hx of traumatic brain & spinal cord injury presents to the ED for post-traumatic seizures.
MRI is ordered.
“No known implanted devices” is checked ✅
Then...The patient nearly suffers a life-threatening complication.
A #ContinuumCase to start the week off!
21 yo👨 w/ a hx of traumatic brain & spinal cord injury presents to the ED for post-traumatic seizures.
MRI is ordered.
“No known implanted devices” is checked ✅
Then...The patient nearly suffers a life-threatening complication.
2/
What device was present?
What device was present?
3/
⛔️ANY of these devices can be MR-unsafe! ⛔️
Many are also MRI-conditional and can result in life-threatening emergencies if the conditions are not followed!
....A further clue🕵️
Several days later the patient has fever, altered mental status, rigidity and another seizure.
⛔️ANY of these devices can be MR-unsafe! ⛔️
Many are also MRI-conditional and can result in life-threatening emergencies if the conditions are not followed!
....A further clue🕵️
Several days later the patient has fever, altered mental status, rigidity and another seizure.
Throwback #ContinuumCase!
A 59 year old developed slowly progressive imbalance and falls. Exam showed a mild spastic quadriparesis.
Cervical T2 and post-contrast T1 MR below. What’s the diagnosis, #neurotwitter?🧵
A 59 year old developed slowly progressive imbalance and falls. Exam showed a mild spastic quadriparesis.
Cervical T2 and post-contrast T1 MR below. What’s the diagnosis, #neurotwitter?🧵
What treatment would you recommend for this patient?
The image demonstrates:
➡️ Multisegment T2 signal prolongation in the cervical cord
➡️ Central canal stenosis
➡️ “Pancakelike” transverse enhancement just below the level of maximal stenosis
➡️ On axial, enhancement mainly in cord white matter
Altogether, suggestive of…
➡️ Multisegment T2 signal prolongation in the cervical cord
➡️ Central canal stenosis
➡️ “Pancakelike” transverse enhancement just below the level of maximal stenosis
➡️ On axial, enhancement mainly in cord white matter
Altogether, suggestive of…
#ContinuumCase!
A 56 year-old developed progressive imbalance and dream enactment behavior. On exam he had an ataxic dysarthria and prominent limb dysmetria
In addition to cerebellar atrophy on his brain MR, you notice a subtle abnormality. What’s going on, #neurotwitter? 🧵
A 56 year-old developed progressive imbalance and dream enactment behavior. On exam he had an ataxic dysarthria and prominent limb dysmetria
In addition to cerebellar atrophy on his brain MR, you notice a subtle abnormality. What’s going on, #neurotwitter? 🧵
Which of the following diagnoses are associated with the “hot cross bun” sign on MRI?
The “hot cross bun” sign is an abnormal appearance (usually T2 prolongation) in a cruciform pattern in the pons
➡️ Thought to reflect degeneration of median raphe nuclei and transverse pontocerebellar fibers
radiopaedia.org/cases/hot-cros…
➡️ Thought to reflect degeneration of median raphe nuclei and transverse pontocerebellar fibers
radiopaedia.org/cases/hot-cros…
#ContinuumCase!
A 71 year old has had 18 months of frequent falls
While eating, he leaves food on the closest part of the plate
His exam shows slow saccades, limb dyspraxia, and axial rigidity
Sagittal T1 MR below. What’s going on here, #neurotwitter? 🧵
A 71 year old has had 18 months of frequent falls
While eating, he leaves food on the closest part of the plate
His exam shows slow saccades, limb dyspraxia, and axial rigidity
Sagittal T1 MR below. What’s going on here, #neurotwitter? 🧵
What’s the most likely diagnosis in this patient?
The combination of
➡️ Falls
➡️ Slowed saccades (especially vertical)
➡️ Axial rigidity
➡️ Midbrain atrophy
All suggest the diagnosis of progressive supranuclear palsy (PSP)
➡️ Falls
➡️ Slowed saccades (especially vertical)
➡️ Axial rigidity
➡️ Midbrain atrophy
All suggest the diagnosis of progressive supranuclear palsy (PSP)
