Discover and read the best of Twitter Threads about #Tweetorials
Most recents (24)
1) Welcome to a đaccredited tweetorial from @cardiomet_CE! We welcome back expert faculty @ChristosArgyrop to discuss screening for #CKD in pts w/ #T2D & the role of routine assessment for #microalbuminuria as an effective diagnostic, risk stratification, & patient ed tool.
2) Christos Argyropoulos MD, PhD @ChristosArgyrop is Division Chief, Nephrology @UNMHSC. #CKD is chronic #kidneydisease, #ESKD is end-stage kidney disease.
#FOAMed #nephtwitter #cardiotwitter @MedTweetorials @NephUCommunity @ISNkidneycare @KidneyDiseaseFm
#FOAMed #nephtwitter #cardiotwitter @MedTweetorials @NephUCommunity @ISNkidneycare @KidneyDiseaseFm
3) This program is intended for #HCPs and is supported by an unrestricted educational grant from Bayer. Statement of accreditation & faculty disclosures at cardiometabolic-ce.com/disclosures/.
FOLLOW US for more expert-authored #tweetorials and earn #MedEd
FOLLOW US for more expert-authored #tweetorials and earn #MedEd
PICC line 𧔠#medicine
1/
A central device (i.e in the SVC) placed via a peripheral venous access
.
#irad #vascular #MedTwitter #FOAMed #hematology #Tweetorials @nihardesai7 @MedTweetorials #Cardiology #MedEd #oncology #internalmedicine @BrownJHM #MedStudentTwitter #cardiotwitter
1/
A central device (i.e in the SVC) placed via a peripheral venous access
.
#irad #vascular #MedTwitter #FOAMed #hematology #Tweetorials @nihardesai7 @MedTweetorials #Cardiology #MedEd #oncology #internalmedicine @BrownJHM #MedStudentTwitter #cardiotwitter
2/
Classically placed in the arm
May be placed in the leg (eg in #pediatrics /neonates â which may then terminate in the infrarenal IVC/iliacs)
.
#criticalcare #cardiovascular
Classically placed in the arm
May be placed in the leg (eg in #pediatrics /neonates â which may then terminate in the infrarenal IVC/iliacs)
.
#criticalcare #cardiovascular
3/
Advantages:
- Lower infection rate then central lines
- Used in the outpatient setting
- Can be used for several weeks to months
- Duration of PICC lines may be from 4 weeks to 6 months
(although they have been known to be functional for more than 300 days)
Advantages:
- Lower infection rate then central lines
- Used in the outpatient setting
- Can be used for several weeks to months
- Duration of PICC lines may be from 4 weeks to 6 months
(although they have been known to be functional for more than 300 days)
Tony @tony_breu holding court on renal physiology in ATN at #ApExPathshala
Is TGF in ischemic ATN good or bad?
Is TGF in ischemic ATN good or bad?
The seminal paper of course is Klaus Thurau on Acute Renal Success
#ApExPathshala pubmed.ncbi.nlm.nih.gov/961698/
#ApExPathshala pubmed.ncbi.nlm.nih.gov/961698/
Without TGF, we would not have Acute Renal Success, we would have âcomplete renal failureâ
@tony_breu At #ApExPathshala
@tony_breu At #ApExPathshala
1) Welcome to this #accredited #tweetorial on genetic testing in the evaluation of patients with cystic kidney disease. #Kidney #cysts are a frequent finding, ranging from simple cysts to suspected or confirmed #ADPKD.
Expert author @dguerrot of @CHURouen đ«đ· leads us!
Expert author @dguerrot of @CHURouen đ«đ· leads us!
2) This program is supported by an educational grant from Otsuka Pharmaceuticals & is intended for #HCPs. #Physicians #Physicianassociates #nurses #nursepractioners #pharmacists đșđžđšđŠđȘđșđŹđ§ earn CE/#CME credit. Statement of accreditation & faculty disclosures ckd-ce.com/disclosures
3a) Fortuitous discovery of non-malignant kidney cysts is increasingly frequent with age, and often leads to #nephrology referral.
Diencephalon location
- around the 3rd ventricle
The cavity of the diencephalon is ----- the 3rd ventricle
All of the structures of the diencephalon are around the 3rd ventricle, so the cavity of the diencephalon is the 3rd ventricle.
2/
- around the 3rd ventricle
The cavity of the diencephalon is ----- the 3rd ventricle
All of the structures of the diencephalon are around the 3rd ventricle, so the cavity of the diencephalon is the 3rd ventricle.
2/
Diencephalon embryology
- prosencephalon
3/
- prosencephalon
3/
The Examination in Coma
âthe father of modern neurological surgeryâ
American neurosurgeon Harvey Williams Cushing (1869â1939)
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âthe father of modern neurological surgeryâ
American neurosurgeon Harvey Williams Cushing (1869â1939)
#MedTwitter #neurotwitter #EndNeurophobia #tweetorials
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Definition
âa state of unarousable unresponsivenessâ
Parts
a. level of consciousness
b. vital signs (BP & breathing pattern)
c. cranial nerves (fundoscopy + vision + brainstem)
d. motor & sensory
e. reflex
f. meningeal signs
2/
âa state of unarousable unresponsivenessâ
Parts
a. level of consciousness
b. vital signs (BP & breathing pattern)
c. cranial nerves (fundoscopy + vision + brainstem)
d. motor & sensory
e. reflex
f. meningeal signs
2/
Level of consciousness
Normal
Clouding of consciousness
Confusion/delirium
Lethargy
Obtundation
Stupor
Coma
3/
Normal
Clouding of consciousness
Confusion/delirium
Lethargy
Obtundation
Stupor
Coma
3/
Drifts!!!
French neurologist Jean Alexandre BarrĂ© (1880â1967)
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French neurologist Jean Alexandre BarrĂ© (1880â1967)
#MedTwitter #neurotwitter #EndNeurophobia #tweetorials
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The four types of drift
âpronator, cerebellar, parietal, and functionalâ
- pronator drift (pyramidal drift) was the 1st to be described
- Dr. Barre was the 1st to report it
2/
âpronator, cerebellar, parietal, and functionalâ
- pronator drift (pyramidal drift) was the 1st to be described
- Dr. Barre was the 1st to report it
2/
Pronator drift (Barreâs sign)
progress from distal to proximal
1st downward arm drift
2nd forearm pronation
3rd flexion of the wrist and elbow
3/
progress from distal to proximal
1st downward arm drift
2nd forearm pronation
3rd flexion of the wrist and elbow
3/
Brachial plexus!!!
âErb-Duchenne palsy, Erb-Charcot paralysis, Erb's point, Erb-Westphal symptom, Erb's spotâ
German neurologist Wilhelm Heinrich Erb (1840â1921)
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âErb-Duchenne palsy, Erb-Charcot paralysis, Erb's point, Erb-Westphal symptom, Erb's spotâ
German neurologist Wilhelm Heinrich Erb (1840â1921)
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1/
Components
âReady To Drink Cold Beerâ
Root (5): C5-T1
Trunk (3): upper, middle, lower
Division (6): anterior & posterior from each of the trunks
Cord (3): lateral, posterior, medial
Branch (5)
2/
âReady To Drink Cold Beerâ
Root (5): C5-T1
Trunk (3): upper, middle, lower
Division (6): anterior & posterior from each of the trunks
Cord (3): lateral, posterior, medial
Branch (5)
2/
How are roots formed?
âformed by the anterior (ventral) rami of C5 to T1 spinal nervesâ
Extent
- interscalene triangle (bounded by anterior scalene and middle scalene)
3/
âformed by the anterior (ventral) rami of C5 to T1 spinal nervesâ
Extent
- interscalene triangle (bounded by anterior scalene and middle scalene)
3/
Signs of tetany!!!
âTrousseau sign of malignancy, Trousseau sign of latent tetany, TrousseauâLallemand bodieâ
French internist Armand Trousseau (1801â1867)
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âTrousseau sign of malignancy, Trousseau sign of latent tetany, TrousseauâLallemand bodieâ
French internist Armand Trousseau (1801â1867)
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1/
Definition
Tetanus
- it is different disease w/ different pathology
Tetanic contractions (physiologic tetanus)
- broad range of muscle contraction types
Tetany
- a type of tetanic contraction
2/
Tetanus
- it is different disease w/ different pathology
Tetanic contractions (physiologic tetanus)
- broad range of muscle contraction types
Tetany
- a type of tetanic contraction
2/
Clinical manifestations of tetany
âspasm and tonic contractions of the skeletal muscles, principally the distal muscles of the extremitiesâ
3/
âspasm and tonic contractions of the skeletal muscles, principally the distal muscles of the extremitiesâ
3/
Meningeal signs
âBrudziĆski neck sign, BrudziĆski symphyseal sign, BrudziĆski cheek sign, Brudzinski's reflexâ
Polish pediatrician JĂłzef Polikarp BrudziĆski (1874â1917)
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âBrudziĆski neck sign, BrudziĆski symphyseal sign, BrudziĆski cheek sign, Brudzinski's reflexâ
Polish pediatrician JĂłzef Polikarp BrudziĆski (1874â1917)
#MedTwitter #neurotwitter #EndNeurophobia #tweetorials
1/
Definitions
Meningitis
-inflammation of leptomeninges & underlying subarachnoid CSF
Meningismus
-morbid state characterized by meningitic syndrome (triad: headache, photophobia, nuchal rigidity)
Meningism
-synonymous of meningismus
-neck stiffness w/o meningeal inflammation
2/
Meningitis
-inflammation of leptomeninges & underlying subarachnoid CSF
Meningismus
-morbid state characterized by meningitic syndrome (triad: headache, photophobia, nuchal rigidity)
Meningism
-synonymous of meningismus
-neck stiffness w/o meningeal inflammation
2/
Mechanism
âmaneuvers used to elicit meningeal signs produce tension on inflamed and hypersensitive spinal nerve roots, and the resulting signs are postures, protective muscle contractions, or other movements that minimize the stretch and distortion of the meninges and rootsâ
3/
âmaneuvers used to elicit meningeal signs produce tension on inflamed and hypersensitive spinal nerve roots, and the resulting signs are postures, protective muscle contractions, or other movements that minimize the stretch and distortion of the meninges and rootsâ
3/
Autonomous Sensory Zones
(peripheral nerves)
Median nerve illustration by Guttmann (1939)
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(peripheral nerves)
Median nerve illustration by Guttmann (1939)
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Definition
âregions where single nerve roots supply distinct and non-overlapping areas of skinâ
- small portion of dermatome
- few nerve roots have such autonomous zones
- great variability
2/
âregions where single nerve roots supply distinct and non-overlapping areas of skinâ
- small portion of dermatome
- few nerve roots have such autonomous zones
- great variability
2/
Sensory zones
a.maximal zone: maximal area supplied by a peripheral nerve
- maximal=intermediate+autonomous
b.intermediate zone: area of overlap of the maximal zone of different peripheral nerves
c.autonomous zone: area exclusively supplied by a particular peripheral nerve
3/
a.maximal zone: maximal area supplied by a peripheral nerve
- maximal=intermediate+autonomous
b.intermediate zone: area of overlap of the maximal zone of different peripheral nerves
c.autonomous zone: area exclusively supplied by a particular peripheral nerve
3/
Inverted & Perverted Reflexes
The first description of the paradoxical (inverted) triceps reflex
French neurologist Alexandre-Achille Souques (1860â1944)
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1/
The first description of the paradoxical (inverted) triceps reflex
French neurologist Alexandre-Achille Souques (1860â1944)
#MedTwitter #neurotwitter #EndNeurophobia #tweetorials
1/
Definition
âelicitation of the movement opposite to that normally seen when the reflex is elicitedâ
2/
âelicitation of the movement opposite to that normally seen when the reflex is elicitedâ
2/
Mechanism
âa lesions simultaneously affecting the roots and spinal cordâ
Damaged root
- interrupt local reflex
- absence of contraction
Damaged spinal cord
- interrupt corticospinal tract
- hyperactive response of the lower spinal segment
3/
âa lesions simultaneously affecting the roots and spinal cordâ
Damaged root
- interrupt local reflex
- absence of contraction
Damaged spinal cord
- interrupt corticospinal tract
- hyperactive response of the lower spinal segment
3/
Myotonic disorders!
âafter a fright, or in an unexpected joyous movement, this convulsive constriction occurs in all limbsâŠthe victim can not stand uprightâ
Prussian physician Asmus Julius Thomas Thomsen (1815â1896)
#MedTwitter #neurotwitter #EndNeurophobia #tweetorials
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âafter a fright, or in an unexpected joyous movement, this convulsive constriction occurs in all limbsâŠthe victim can not stand uprightâ
Prussian physician Asmus Julius Thomas Thomsen (1815â1896)
#MedTwitter #neurotwitter #EndNeurophobia #tweetorials
1/
Definition
âdifficulty in relaxation of a muscle after maximum voluntary contractionâ
It can be specifically
- aggravated by conditions
- affecting regions of the body
- triggered
2/
âdifficulty in relaxation of a muscle after maximum voluntary contractionâ
It can be specifically
- aggravated by conditions
- affecting regions of the body
- triggered
2/
Myotonic or Tennessee fainting goat
âimportant in history due to role of chloride channel in muscle excitationâ
- 1880s, Marshall County
- CLCN1 gene
via: jimmywan87
3/
âimportant in history due to role of chloride channel in muscle excitationâ
- 1880s, Marshall County
- CLCN1 gene
via: jimmywan87
3/
Dermatome!!!
âDermatomal man, early twentieth centuryâ
University of Edinburgh Image Collections
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âDermatomal man, early twentieth centuryâ
University of Edinburgh Image Collections
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History
âdermatomal charts are primarily derived from 3 sourcesâ
Head & Campbell
-herpetic eruptions
Foerster
-rhizotomy in chronic pain
-dermatomal overlap
Keegan & Garrett
-various diseases
-exam & surgical correlate: 53%
American neurosurgeon John Jay Keegan(1889-1978)
2/
âdermatomal charts are primarily derived from 3 sourcesâ
Head & Campbell
-herpetic eruptions
Foerster
-rhizotomy in chronic pain
-dermatomal overlap
Keegan & Garrett
-various diseases
-exam & surgical correlate: 53%
American neurosurgeon John Jay Keegan(1889-1978)
2/
Definition
âarea of skin in which sensory nerve derive from a single spinal nerve rootâ
- 31 spine segments
8C + 12T + 5L + 5S + 1 coccygeal
- dermatomes exist for each spinal nerve, except C1
3/
âarea of skin in which sensory nerve derive from a single spinal nerve rootâ
- 31 spine segments
8C + 12T + 5L + 5S + 1 coccygeal
- dermatomes exist for each spinal nerve, except C1
3/
Hereditary Ataxias!!!
Spinocerebellar ataxias (SCA)
âSCA1 âŠ. the unstable CAG trinucleotide repeat expansionâ
American geneticist Harry T. Orr
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Spinocerebellar ataxias (SCA)
âSCA1 âŠ. the unstable CAG trinucleotide repeat expansionâ
American geneticist Harry T. Orr
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1/
SCA definition
âcomplex group of heterogeneous degenerative diseases of the cerebellum and its connectionsâ
2/
âcomplex group of heterogeneous degenerative diseases of the cerebellum and its connectionsâ
2/
Worldwide distribution of SCA subtypes
21% SCA3, Brazil & Portugal
15% SCA2, India & Singapore
15% SCA6, Japan & Germany
6% SCA1, South Africa
5% SCA7, South Africa
3% SCA8, worldwide
<1% rare
SCA 10, SCA 12, SCA 14, SCA17
3/
21% SCA3, Brazil & Portugal
15% SCA2, India & Singapore
15% SCA6, Japan & Germany
6% SCA1, South Africa
5% SCA7, South Africa
3% SCA8, worldwide
<1% rare
SCA 10, SCA 12, SCA 14, SCA17
3/
Dancing larynx!!!
âa variant of palatal tremor?â
British neurologist Anette-Eleonore Schrag
1999, first description
@UCLIoN
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1/
âa variant of palatal tremor?â
British neurologist Anette-Eleonore Schrag
1999, first description
@UCLIoN
#MedTwitter #neurotwitter #EndNeurophobia #tweetorials
1/
Definition
ârhythmic vertical laryngeal cage movements of varying frequency with synchronous movements of the tongue, posterior pharynx, and the palatopharyngeal archâ
- not affecting uvula
2/
ârhythmic vertical laryngeal cage movements of varying frequency with synchronous movements of the tongue, posterior pharynx, and the palatopharyngeal archâ
- not affecting uvula
2/
Pathophysiology
Variant of palatal tremor
- oscillatory firing of neurons in the inferior olives
Functional
3/
Variant of palatal tremor
- oscillatory firing of neurons in the inferior olives
Functional
3/
Rabbit syndrome!!!
âa peculiar extrapyramidal reactionâ
Canadian psychiatrist André Villeneuve
1972, the first report
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1/
âa peculiar extrapyramidal reactionâ
Canadian psychiatrist André Villeneuve
1972, the first report
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1/
Definition
âstereotyped vertical, rhythmic movements, similar to the chewing movements of a rabbitâ
5 Hz
Lips produce a popping sound
Not tardive dyskinesia!
- persist stage I sleep
2/
âstereotyped vertical, rhythmic movements, similar to the chewing movements of a rabbitâ
5 Hz
Lips produce a popping sound
Not tardive dyskinesia!
- persist stage I sleep
2/
Pathophysiology
- cholinergic system?
3/
- cholinergic system?
3/
Belly Dancer's Dyskinesia!!!
âfirst described by Antonie van Leeuwenhoek in 1723 when he himself experienced the symptomsâ
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1/
âfirst described by Antonie van Leeuwenhoek in 1723 when he himself experienced the symptomsâ
#MedTwitter #neurotwitter #EndNeurophobia #tweetorials
1/
Definition
ârhythmic, involuntary contractions of the diaphragm resulting in undulating, rhythmic movements of the abdomen resembling a belly danceâ
-bilateral, most freq
-limited to axial musculature
-sometimes painful
-no suppress on breath holding
-150 contraction/min
2/
ârhythmic, involuntary contractions of the diaphragm resulting in undulating, rhythmic movements of the abdomen resembling a belly danceâ
-bilateral, most freq
-limited to axial musculature
-sometimes painful
-no suppress on breath holding
-150 contraction/min
2/
History
1723, Leeuwenhoek
- 1st report
- diaphragmatic flutter
1976, Nichols
- 1st report
- abdominal wall dyskinesia
- phrenic palsy in a newborn
1990, Iliceto
â diaphragmatic flutter
3/
1723, Leeuwenhoek
- 1st report
- diaphragmatic flutter
1976, Nichols
- 1st report
- abdominal wall dyskinesia
- phrenic palsy in a newborn
1990, Iliceto
â diaphragmatic flutter
3/
Jack-in-the-box tongue!!!
âThe English Hippocratesâ
English physician Thomas Sydenham (1624 â 1689)
discovered Sydenham's chorea
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âThe English Hippocratesâ
English physician Thomas Sydenham (1624 â 1689)
discovered Sydenham's chorea
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1/
Pathophysiology
âcombination of chorea & motor impersistenceâ
2/
âcombination of chorea & motor impersistenceâ
2/
Definition
âunable to maintain tongue in protruded state and the tongue moves in and outâ
3/
âunable to maintain tongue in protruded state and the tongue moves in and outâ
3/
Milkmaidâs grip!!!
âmotor impersistence of the handâ
Philippus Aureolus Theophrastus Paracelsus Bombastus von Hohenheim (1493â1541)
(Paracelsus)
first coined the term Chorea Sancti Viti
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âmotor impersistence of the handâ
Philippus Aureolus Theophrastus Paracelsus Bombastus von Hohenheim (1493â1541)
(Paracelsus)
first coined the term Chorea Sancti Viti
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1/
Pathophysiology
âcombination of chorea & motor impersistenceâ
Motor impersistence
- inability to maintain tetanic muscle contraction
- positioning & compensatory repositioning
- independent of chorea
- linearly progressive (marker of disease severity?)
- frontal lobe
2/
âcombination of chorea & motor impersistenceâ
Motor impersistence
- inability to maintain tetanic muscle contraction
- positioning & compensatory repositioning
- independent of chorea
- linearly progressive (marker of disease severity?)
- frontal lobe
2/
Examples of motor impersistence
- Milkmaidâs grip
- inability to maintain eye closure
- âJack in the boxâ tongue
3/
- Milkmaidâs grip
- inability to maintain eye closure
- âJack in the boxâ tongue
3/
I've seen two patients in my training with ring chromosome 20 associated epilepsy, which inspired my recent talk at #CleClinicNeuro Peds Epilepsy GR, so I decided to distill it to a #neurogenetics #epilepsy #tweetorial đ€ đ§Ź
1/đ§”
1/đ§”
what is a đ chromosome? Rather than having a full complement of rod-shaped chromosomes like this:
2/ đ§”
2/ đ§”
affected individuals have at least one chromosome with circular formation, due to fusion of distal chromosome regions:
3/ đ§”
3/ đ§”
Glabellar reflex (Myerson's sign)!!!
"the preliminary note on a new cranial reflex"
British doctor Walker Overend (1858â1926)
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1/
"the preliminary note on a new cranial reflex"
British doctor Walker Overend (1858â1926)
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1/
Glossary
Glabellar reflex
Habituation
Myersonâs sign
Primitive reflex
2/
Glabellar reflex
Habituation
Myersonâs sign
Primitive reflex
2/
History
1896, Dr. Walker Overend
- first report
1901, Dr. Daniel J. McCarthy
- published a 2nd report without acknowledging Overend
1944, Dr. Abraham Myerson
- observed, mainly, in PD
1954, Dr. Doshay
- called Myersonâs sign
3/
1896, Dr. Walker Overend
- first report
1901, Dr. Daniel J. McCarthy
- published a 2nd report without acknowledging Overend
1944, Dr. Abraham Myerson
- observed, mainly, in PD
1954, Dr. Doshay
- called Myersonâs sign
3/
Wing-beating tremor!!!
âpseudosclerotic, parkinsonism, and dystonic/choreic forms of Wilsonâs diseaseâ
American-born British neurologist Samuel Alexander Kinnier Wilson (1878â1937)
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âpseudosclerotic, parkinsonism, and dystonic/choreic forms of Wilsonâs diseaseâ
American-born British neurologist Samuel Alexander Kinnier Wilson (1878â1937)
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1/
Pathophysiology
âlesion in the dentatorubrothalamic pathwayâ
- cerebellar outflow pathway
Complex phenomenology
- dystonic, myoclonic, rhythmic tremor?
2/
âlesion in the dentatorubrothalamic pathwayâ
- cerebellar outflow pathway
Complex phenomenology
- dystonic, myoclonic, rhythmic tremor?
2/
Definition
âlow-frequency, high-amplitude, posture-induced proximal arm tremor, elicited by sustained abduction of the arms, with flexed elbows and palms facing downwardâ
- postural tremor
- wing-beating posture
3/
âlow-frequency, high-amplitude, posture-induced proximal arm tremor, elicited by sustained abduction of the arms, with flexed elbows and palms facing downwardâ
- postural tremor
- wing-beating posture
3/
Nystagmus series â Part VII
(seesaw & hemi-seesaw nystagmus)
âMaddox rod, double prism Maddox, red glass Maddox, Maddox cross, and Maddox wingâ
British ophthalmologist Ernest Edmund Maddox (1863â1933)
(first report)
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(seesaw & hemi-seesaw nystagmus)
âMaddox rod, double prism Maddox, red glass Maddox, Maddox cross, and Maddox wingâ
British ophthalmologist Ernest Edmund Maddox (1863â1933)
(first report)
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1/
Definition
âone half-cycle of elevation&intorsion of one eye
and
synchronous depression&extorsion of the other eye.
Next half-cycle,
vertical&torsional components are reversedâ
- waveform: pendular (seesaw) & jerk (hemi-seesaw)
- hemi-seesaw: only one half-cycle
2/
âone half-cycle of elevation&intorsion of one eye
and
synchronous depression&extorsion of the other eye.
Next half-cycle,
vertical&torsional components are reversedâ
- waveform: pendular (seesaw) & jerk (hemi-seesaw)
- hemi-seesaw: only one half-cycle
2/
Pathophysiology
Jerk (hemi-seesaw)
- lesion in the interstitial nucleus of Cajal
Pendular (seesaw)
- parasellar (midbrain compression & visual field defects)
- calibration lesion
3/
Jerk (hemi-seesaw)
- lesion in the interstitial nucleus of Cajal
Pendular (seesaw)
- parasellar (midbrain compression & visual field defects)
- calibration lesion
3/
