Neurology @neropsychtel Channel on Telegram

Neurology

@neropsychtel

Neurology and psychiatry books and YouTube short notes

Neurology and Psychiatry Books Channel (English)

Are you interested in expanding your knowledge of neurology and psychiatry? Look no further than the 'Neurology and Psychiatry Books Channel' on Telegram, also known as @neropsychtel. This channel is dedicated to providing you with a vast collection of books and YouTube short notes related to neurology and psychiatry. Whether you are a medical student, a healthcare professional, or simply someone who is curious about these fascinating fields, this channel has something for everyone. From textbooks to research articles, from case studies to video lectures, you will find a wealth of resources to deepen your understanding of the human brain and behavior. Stay updated with the latest advancements in neurology and psychiatry by joining this channel today. Don't miss out on this incredible opportunity to enhance your knowledge and broaden your horizons in the world of neurology and psychiatry.

Neurology

04 Dec, 14:45

Tic disorders (TDs)

TDs, first described in 1825, are characterized by sudden, brief, intermittent, involuntary or semivoluntary movement (motor tics) or vocalization (vocal tics).
Motor tics often cause brief, jerking movements, more sustained twisting movements, or long-sustained muscle contractions involving the face, neck, shoulders, limbs, and trunk.
Vocal tics typically arise from rapid contraction of the #oropharynx, #throat, and respiratory muscles.
Both tics can be classified as simple and complex, can be suppressed voluntarily for short periods, and are often preceded by premonitory sensations. According to the DSM-5, idiopathic TDs can be classified into 3 types:
1. transient TD,
2. chronic TD,
3. Tourette syndrome (TS).

The reported prevalence of tics in children varies significantly. Transient TD, chronic TD, and TS affect 20%, 0.3%–5.0%, and 0.3%–1.0% of children and adolescents, respectively. In addition, TS is frequently accompanied by various psychopathologic comorbidities, including
A. ADHD,
B. OCD,
C. learning difficulties,
D. anxiety,
E. self-injurious behavior.
445
Neurology

03 Dec, 18:57

Causes of Floppy Infants

1. Central Nervous System Disorders
_Cerebral palsy
_Developmental delay from primary metabolic disorders

2. Mixed (Central and Peripheral)
_Metachromatic leukodystrophy and other lipidosis
_Neuroaxonal atrophy
_Giant axonal neuropathy
_Merosin-deficient muscular dystrophy, other congenital muscular dystrophies (e.g., Fukuyama type)
_Anterior Horn Cell Diseases
_Infantile spinal muscular atrophy

3. Neuropathies
_Charcot-Marie-Tooth disease, particularly types 3 and 4

4. Diseases of the neuromuscular junction
_Congenital myasthenic syndromes
_infantile botulism
_Neonatal transient autoimmune myasthenia gravis

5. Myopathies
_Infantile metabolic myopathies (e.g., acid maltase deficiencies or
_Pompe disease, infantile phosphorylase deficiency)
_Congenital muscular dystrophy
_Other congenital myopathies (e.g., central core disease, myotubular myopathy, nemaline myopathy)
_Congenital myotonic dystrophy
_Myopathy from electrolyte and endocrine abnormalities
607
Neurology

03 Dec, 07:07

Chiari malformation

• Chiari 1 malformation (CM1); synonyms: Chiari type 1, Chiari1 deformity, cerebellar tonsillar ectopia

IMAGING
• Pointed cerebellar tonsils extending ≥ 5 mm belowforamen magnum (basion-opisthion/McRae line) with effacement of CSF spaces
• ± retroflexed odontoid, horizontal shortened #clivus, basilarinvagination, atlanto-occipital assimilation
• ± caudal descent of brainstem, brainstem compression,medullary kink
• ± syringohydromyelia, #scoliosis

TOP DIFFERENTIAL DIAGNOSES
• Normal low-lying cerebellar tonsils
• Chiari 2 malformation
• Tonsillar herniation secondary to increase ICP
• Intracranial hypotension
PATHOLOGY
• Most common cause believed to be small/underdevelopedposterior fossa; no association with open spinal #dysraphism
• Can be result of premature closure of sutures
○ Causes include shunted infantile #hydrocephalus, bonedysplasias, genetic syndromes

CLINICAL ISSUES
• Most common presenting symptom: Occipital #headache
○ Up to 30% of patients asymptomatic
• Goal of surgery in symptomatic patients: Restore normalCSF flow at foramen magnum
○ Suboccipital decompression, resection of C1 posteriorarch ± duraplasty, cerebellar tonsil cautery

DIAGNOSTIC CHECKLIST
• Look for presence of syrinx → makes surgical interventionmore likely
677
Neurology

30 Nov, 22:25

Glial cells
Glial cells provide the supportive cellular structure and function for neurons.
Approximately 10 times more glial cells exist than neurons. Glial cells are the principal cell types that proliferate to form CNS tumors; neurons rarely form tumors.
i. Astrocytic functions act as scaffolding between neurons, sequester ions (potassium), insulate synaptic sites, provide trophic and molecular support for neurons.
ii. Oligodendrocyte function provide myelination of axons
iii. Microglial functions phagocytize debris, participate in inflammatory responses, present antigens, and provide other immunologic and cytokine reactivity

figure
1. Microglial cell
2. #Oligodendrocyte
3. Axon
4. Perivascular pericyte
5. Astrocytic foot process
6. #Astrocyte
7. Pia mater cells
8. #Neuron
9. Tanycyte
10. Ependymal cell

#neurologyclinic #STROKE #Neuropathy #anatomy #subarachnoid #Aphasia #stroke
880
Neurology

30 Nov, 14:13

Spontaneous intracerebral hemorrhage (ICH) accounts for 10%–30% of all strokes but half of the disability adjusted life years lost due to stroke globally.
The most frequent causes of ICH are
1. sporadic cerebral small vessel diseases (SVDs; #arteriolosclerosis or cerebral amyloid #angiopathy)—reported to account for around 80% of cases,
2. macrovascular causes (e.g., AVM, aneurysm, or cavernoma), which account for most of the remainder.

👉CTA is a first-line investigation to identify most macrovascular causes of acute ICH.
👉The reference standard for detection of most macrovascular causes is digital subtraction angiography (DSA), an invasive procedure requiring interventional #neuroradiologist.
906
Neurology

29 Nov, 01:47

Myocardial Infarction

Stroke in the presence of myocardial infarction is more common for patients who have 1 or more of the following risk factors:
1. older age,
2. apical or anterior wall MI,
3. left ventricular dysfunction or AF,
4. mural thrombi or severe wall motion abnormality seen on #echocardiography,
5. prior history of #stroke,
6. #hypertension, or
7. history of systemic or pulmonary #embolism.
The stroke risk is highest in the first week after MI, but the increased risk persists for up to 6 months. Short term #anticoagulation in addition to #aspirin may be recommended for high-risk patients with a recent MI.

Figure:
Causes of #cardioembolic stroke

https://youtube.com/playlist?list=PL2XcrMWxPBLSatx3yNt2kmrdNpK_0o3k5&si=bCJdD9u8IzF9PX2-

https://www.facebook.com/share/p/19d75F8VdL/

#Holter #SORA #thromboembolism #disease #brain 🧠🧠🧠
1,185
Neurology

27 Nov, 19:55

TERMINAL BRANCHES OF INTERNATIONAL CAROTID ARTERY

• Anterior cerebral artery (ACA)

👉A1 segment (horizontal segment, precommunicating segment)
◦ Medial lenticulostriate arteries
◦ Recurrent artery of Heubner (medial
striate artery)
👉A2 segment (vertical segment, postcommunicating segment)
◦ Frontopolar artery
👉A3 segment (callosal segment)
– Anterior communicating artery

• Middle cerebral artery (MCA)
✍️M1 segment (sphenoidal/horizontal segment)
◦ Thalamostriate arteries
◦ Lateral lenticulostriate arteries
◦ Anterior temporal artery
✍️M2 segment (insular segment)
◦ Insular arteries
✍️M3 segment (opercular segment)
◦ Insular arteries
◦ Frontobasal arteries
◦ Temporal arteries
✍️M4 segment (terminal segment)
◦ Arteries of the precentral and triangular
sulci
◦ Anterior and posterior parietal arteries
◦ Arteries of the central and postcentral
sulci.

#neurology #SORA #stroke #brain 🧠🧠
1,160
Neurology

27 Nov, 17:37

TERMINAL BRANCHES OF INTERNATIONAL CAROTID ARTERY

• Anterior cerebral artery (ACA)

👉A1 segment (horizontal segment, precommunicating segment)
◦ Medial lenticulostriate arteries
◦ Recurrent artery of Heubner (medial
striate artery)
👉A2 segment (vertical segment, postcommunicating segment)
◦ Frontopolar artery
👉A3 segment (callosal segment)
– Anterior communicating artery

• Middle cerebral artery (MCA)
✍️M1 segment (sphenoidal/horizontal segment)
◦ Thalamostriate arteries
◦ Lateral lenticulostriate arteries
◦ Anterior temporal artery
✍️M2 segment (insular segment)
◦ Insular arteries
✍️M3 segment (opercular segment)
◦ Insular arteries
◦ Frontobasal arteries
◦ Temporal arteries
✍️M4 segment (terminal segment)
◦ Arteries of the precentral and triangular
sulci
◦ Anterior and posterior parietal arteries
◦ Arteries of the central and postcentral
sulci.

#neurology #SORA #stroke #brain 🧠🧠
947
Neurology

25 Nov, 19:03

The choroid plexus (CP) is a highly vascularized tissue located in the 4 cerebral ventricles, involved in the production of CSF. The CP serves as an interface between blood and CSF, termed the blood-cerebrospinal fluid barrier (BCSFB).
The CP is made of a stroma rich in fenestrated #capillaries, covered by a specialized single layer of epithelial cells that regulates the composition of the CSF.
The CP is also believed to be involved in many other functions, such as #neurogenesis, #neuroprotection, and soluble waste product clearance. For this reason, CP has been studied to provide insight into the pathologic processes of #neuroimmune, #neurodegenerative, and psychiatric disorders, such as
1. multiple sclerosis (MS),
2. Alzheimer #dementia,
3. #schizophrenia.

#neurology #brain 🧠
1,168
Neurology

24 Nov, 14:29

MOGAD

Optic disc edema affects 86% of cases.
Bilateral optic neuritis in 50% of cases.
6%-14% of patients have residual visual acuity 20/200 or less.( One third in AQP4+VE NMOSD).
50% develop relapse and some exhibit a glucocorticoids dependent course fulfilling criteria for CRION.

FIGURE::
SEVER CASE OF OPTIC DISC EDEMA UP TO PERIPAPILLARY HEMORRHAGE

https://youtu.be/-78PEWfUc1Y?si=BRhnwMPcH-s1GhSq

#neuroimmunology #neurology #brain 🧠🧠🧠💯🧠🧠🧠⬆️🧠
1,448
Neurology

24 Nov, 07:32

The Emergency Neurological Life Support (ENLS) acute ischemic stroke (AIS) protocol.

https://youtube.com/playlist?list=PL2XcrMWxPBLSatx3yNt2kmrdNpK_0o3k5

#neurology #stroke #sixty
1,351
Neurology

23 Nov, 19:33

Erdheim Chester disease

Erdheim-Chester disease is a systemic lipogranulomatous disorder with #infiltration by lipid-laden histiocytes (foamy macrophages), Touton giant cells, and a variable amount of background #fibrosis

The clinical presentation

The most common presenting symptom is bone pain. However, patients may also present with:
1. focal neurological deficits,
2. exophthalmos,
3. retroperitoneal fibrosis,
4. diabetes insipidus,
5. dyspnea due to the variably extensive extraskeletal involvement of the disease.
1,319
Neurology

23 Nov, 10:04

Current Inclusion and Exclusion Criteria for IV alteplase based on AHA/ASA 2019 guidelines.

Abbreviations:

LKW, last known well;
mRS, modified Rankin scale.

https://youtu.be/6TrohMqTSB8?si=UObQRr-CYOLes6ma

#STROKE #neurology #neuroscience #gene #seizure #Neuropathy #stroke #anatomy
1,270
Neurology

22 Nov, 22:08

Amyotrophic lateral sclerosis

Combined anterior horn and pyramidal
tract syndromeseen in amyotrophic lateral sclerosis as the result of
degeneration of both cortical and spinal motor neurons.
The clinical picture is a combination of
flaccid and spastic paresis.
Muscle atrophy, appearing early in the course of the disease, is generally so severe that the deep tendon reflexes would ordinarily be absent, if only the lower motor neurons were affected. Yet, because of the simultaneous damage of the upper motor neurons (with consequent pyramidal tract degeneration and spasticity), the reflexes often remain elicitable and may even be exaggerated. Accompanying degeneration of the motor cranial
nerve nuclei can cause dysarthria and dysphagia (progressive bulbar palsy).

https://youtube.com/playlist?list=PL2XcrMWxPBLRIFeiviK7iovbwAJrw6kXt&si=Vop9NWfgLXKez_0Z

#neurologyclinic #STROKE #neurology #neuroscience #Neuropathy #neuroradiology #hemorrhage #Aphasia #subarachnoid
1,462
Neurology

20 Nov, 06:21

Complications of SAH

Rebleeding.
Rebleeding is heralded by:
1. a sudden worsening of headache,
2. vomiting,
3. blood pressure elevation,
4. development of a new neurologic deficit, or arrhythmia.

It occurs in up to 1/3 of patients and has a mortality rate of up to 70%. The risk of rebleeding is greatest during the first 24 hours (4%–14%), declining rapidly over
the next 2 weeks.
Rates of rebleeding are highest in
A. patients with seizure or loss of consciousness at onset,
B. previous sentinel headaches,
C. large aneurysm size,
D. those who are a poor clinical grade,
E. those who have hypertension,
F. longer time to aneurysm treatment.

Rerupture is associated with a significantly high mortality
1,500
Neurology

19 Nov, 15:47

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)

CIDP consists of a spectrum of #autoimmune diseases of the peripheral nerves, causing weakness and sensory symptoms.
#Diagnosis often is challenging, because of the heterogeneous presentation and both mis- and underdiagnosis are common.
The EFNS/PNS criteria had the highest sensitivities, with good specificities.
NCS abnormalities suggestive of demyelination are mandatory to fulfill the diagnostic criteria. On the one hand, performance and interpretation of NCS can be difficult and none of these demyelinating findings are specific for CIDP. On the other hand, not all patients will be detected despite the relatively high sensitivity of NCS abnormalities. The electrodiagnostic criteria can be supplemented with additional diagnostic tests such as CSF examination, MRI, nerve biopsy, and somatosensory evoked potentials.

https://youtu.be/AYEhL1LdONY?si=e8Di3A5UWAa1Rlds
1,675
Neurology

19 Nov, 03:56

CIDP

Autoimmune #nodopathy is a rare, debilitating, demyelinating polyneuropathy triggered by autoantibodies targeting peripheral nerve nodal and paranodal proteins including:
1. neurofascin-155 (NF155),
2. contactin-1 (CNTN1),
3. contactin-associated protein-1 (CASPR1),
4. neurofascin-186/140 (NF186/NF140).
721
Neurology

17 Nov, 13:46

Diffuse leptomeningeal enhancement, predominantly in the brainstem 👈.

#neuroradiology
892
Neurology

17 Nov, 05:05

Secondary headaches are the expression of an underlying disease.

Ruling out secondary headaches is a major responsibility of the emergency department (ED) staff

Diagnosis of secondary headache is easy if we used the acornym #SNNOOP10 or #SNOOP4.

FIG1
Algorithm for headache

Fig2
SNNOOP10

https://www.youtube.com/watch?v=SaWSrIIwLRU

#neurology #neuroscience #neurosurgery #sixty #headache #headaches #headacherelief #headachetreatment
937
Neurology

16 Nov, 17:33

Sturge-Weber syndrome (encephalotrigeminal angiomatosis)

It is a neurocutaneous disorder characterized by angiomas involving the face, choroid, and leptomeninges. It is the third most common neurocutaneous syndrome after neurofibromatosis and tuberous sclerosis.
The facial capillary vascular malformation is also known as "port-wine stain" or "nevus flammeus" and usually is seen in the territory of the trigeminal nerve.

#neuroscience #neurology #gene #tumor #seizure
909
Neurology

15 Nov, 16:13

#Neuromyelitis_optica_spectrum_disorder (NMOSD)

NMOSD includes relapsing inflammatory #demyelinating disorders affecting the #CNS and, more specifically, the #spinal cord and the optic #nerve.

3 different subtypes have been described depending on the serostatus of patients:
1. positive antiaquaporin-4 antibody (NMOSD-AQP4+),
2. positive antimyelin oligodendrocyte glycoprotein antibody (NMOSD-MOG+),
3. double-seronegative (NMOSD-DN)

Because of a broad clinical spectrum than “classical” NMOSD4 and different pathologic mechanisms, patients with anti-MOG antibodies were reclassified as MOG antibody–associated disease (MOGAD) with recent international diagnostic criteria.

https://youtu.be/-78PEWfUc1Y?si=6Zvw29njxwOrc6wl

#neurology #neuroscience #neuroimmunology #immunology #immunotherapy
998
Neurology

14 Nov, 02:44

1 Cingulate sulcus
2 Parieto-occipital sulcus
3 Genu of corpus callosum
4 Septum pellucidum
5 Fornix
6 Splenium of corpuscallosum
7 Paraterminal gyrus
8 Anterior commissure
9 Interthalamic adhesion
10 Third ventricle
11 Posterior commissure
12 Pineal gland
13 Left frontal sinus
14 Lamina terminalis
15 Mammillary body
16 Oculomotor nerve
17 Tegmentum of midbrain
18 Superior colliculus
19 Inferior colliculus
20 Culmen (IV, V)
21 Tentorium of cerebellum
22 Olfactory bulb and tract
23 Optic nerve
24 Optic chiasm
25 Infundibulum
26 Primary fissure of
cerebellum
27 Pituitary gland
28 Pons
29 Declive (VI)
30 Folium of vermis (VII A)
31 Sphenoid sinus
32 Fourth ventricle
33 Nodule of vermis (X)
34 Nasal septum
35 Abducens nerve (within the slice)
36 Medulla oblongata
37 Uvula of vermis (IX)
38 Pyramis of vermis (VIII)
39 Pharyngeal tonsil
40 Obex of medulla oblongata
41 Tonsil of cerebellum (H IX)
42 Nasopharynx
43 Central canal
44 Oral cavity
45 Spinal cord
46 Uvula of palate
47 Tongue
48 Oropharynx
1,141
Neurology

13 Nov, 16:18

A 19-year-old male is brought into the emergency department by the police. The patient was arrested earlier in the evening after initiating a fight at a party.
He was very aggressive, and it took multiple officers to restrain and arrest the patient. Shortly after his arrest, he became unresponsive. A computed tomography scan of his head, complete blood count, and electrolytes are normal. Urinary analysis is normal except for myoglobinuria. On examination the patient
is somnolent but arousable with painful stimulation.
He is hypertensive, is febrile, and has both vertical and
horizontal nystagmus.
1,059
Neurology

13 Nov, 16:04

A 75-year-old male presents with an acute stroke. On examination he has mild right arm and face weakness. He has spontaneous speech with occasional paraphasic errors. He can understand and follow commands. Repetition is severely impaired.
837
Neurology

13 Nov, 14:44

A 12-year-old boy presents to the office for evaluation of weakness. With exercise, he gets cramps and fatigue in his legs to the extent that he is unable to keep up with his peers during gym class. Cramps usually occur within minutes of starting exercise, and he seems to get a “second wind” if he is able to rest for a few minutes after the cramps begin. He denies dark urine. His neurological examination is normal. Serum creatine kinase (CK) level is elevated at 650 IU/L (normal is usually 50–200 IU/L). An exercise forearm test is performed and shows a normal rise in ammonia, but no rise in the lactate
805
Neurology

13 Nov, 14:39

45-year-old female with a history of hyperlipidemia, HTN, and gout presents with a 2-week history of progressive pain in her shoulders and hips. She has difficulty reaching objects in her tall kitchen cabinets and has noticed the need to use her arms when rising
from a chair.
734
Neurology

12 Nov, 17:40

#SAH

#Blood is no longer documented by CT within a week following SAH onset, and if hyperdensity persist beyond this period, it is more likely due to #rebleeding.
In the #subacute phase, typically more than 3 days after the #bleed, and especially in #chronic cases, a rapid decline in CT sensitivity is usually mirrored by increasing MRI #sensitivity.
In certain studies, MR has proved to be 100% accurate in cases studied 3 days and more after onset of SAH; in particular this has been observed in those cases where FLAIR sequences have been used, making it the technique of choice in the subacute phase of SAH.
743
Neurology

12 Nov, 04:18

Schematic drawing of the meningeal spaces (reproduced from Heimer (1983) with kind permission by Springer Nature)

#STROKE #neurology #neuroscience #gene #seizure #Neuropathy #neuroradiology #hemorrhage #stroke #Aphasia #subarachnoid #anatomy #postgadolinium #hydrocephalus #tumor #metastases #coma #ataxia #somnolence #moyamoya #Zokinvy
829
Neurology

11 Nov, 04:25

SAH

Patients with poor neurological status may require early surgery aimed at addressing complications such as acute #hydrocephalus and intraparenchymal haematomas. Such #surgery can remove the viscous clots from the basal subarachnoid cisterns and place clips on aneurysms before #vasospasm develops
955
Neurology

10 Nov, 03:30

Inherited peripheral neuropathies (IPNs)

IPNs are a group of inherited diseases affecting the PNS with a wide range of symptoms, clinical severity and causes. IPNs may be AD, AR, X-linked and mitochondrial and are grouped depending on the peripheral neurons involved:
A. Hereditary motor and sensory neuropathies,
B. Hereditary motor neuropathies
C. Hereditary sensory and autonomic neuropathies.
The most common form is HMSN ( CMT), prevalence 1 in 2500. CMT is divided into 3 types depending on pathophysiology:
1. Demyelinating (CMT1),
2. Axonal (CMT2),
3. Intermediate (CMTi)
In CMT1, the 1ry pathology is degeneration of myelin sheath leading to NCV reduction, whereas axon degeneration is the 1ry pathology in CMT2
In CMTi, NCVs overlap CMT1 and CMT2, and may show pathology of both CMT1 and CMT2
IPN may present with other features including metabolic or mitochondrial dysfunction, neurodegenerative disorders including hereditary ataxias, and leukodystrophy; or may be part of a complex multisystem disorder
1,147
Neurology

09 Nov, 11:37

Cortical laminar necrosis (CLN)
CLN is radiologically defined as high intensity cortical lesions on T1 weighted MRI images following a gyral distribution. Histopathologically, CLN is characterised by #pannecrosis of the cortex involving neurones, glial cells, and blood vessels. It has been reported to be associated with #hypoxia, metabolic disturbances, drugs, and infections.
Cerebral #ischemia and hemorrhage are known complications of PRES, but CLN, characterized by disrupted energy supply to the cerebral cortex and subsequent neuronal cell #death, is uncommon in PRES.
After reduction of cyclosporine, repeat MRI a month later showed reduced vasogenic #edema while CLN evidence remained stable. This reversibility supports the #diagnosis of PRES with CLN rather than the less likely scenario of diffuse symmetric parenchymal infarction.

https://youtu.be/jnyVDKuZ_kw?si=9l0yEREzTHuoLDcr

https://youtu.be/WZKLOfWpB4w?si=dPPPDQOcT1ob_xwo

#STROKE #neuroscience
697
Neurology

07 Nov, 18:20

Topographic Localization of Third Nerve Lesions

There are three major regions where a third nerve le sion may be produced:
(1) nuclear, or within the third nerve nucleus;
(2) fascicular, or involving the fibers of the third nerve within the brainstem;
(3) subarachnoid, or involving the third nerve as it passes through the subarachnoid space.

fig: Localization of third nerve lesions.

https://www.youtube.com/watch?v=h23OI_uHIPs&t=51s
824
Neurology

07 Nov, 04:38

Wolff White Parkinson syndrome

Cardioembolic stroke

https://youtube.com/playlist?list=PL2XcrMWxPBLSatx3yNt2kmrdNpK_0o3k5&si=czDmJfMU-qRbKdsN

#neurology #stroke
783
Neurology

06 Nov, 04:24

Prehospital assessment

Community education on stroke symptoms and early EMS access are critical components of any regional stroke system, the “FAST” stroke recognition tool is being used to educate the public on stroke. The presence of facial droop, arm weakness, or diffculty with speech could represent ongoing stroke and thus should prompt people to act FAST and call EMS for the sake of time. Recently, balance and eye symptoms have been incorporated into the patient’s education tools such as the BE-FAST, recognizing the importance of posterior circulation stroke.

https://youtu.be/6TrohMqTSB8?si=0M6I9hFcRsPHvot7
888
Neurology

05 Nov, 12:42

A woman presents with altered mental status and hyper ammonemia after being prescribed valproic acid. She has a history of recurrent vomiting attributed to a migraine variant. The patient and her mother are vegetarians. The patient’s brother died in the newborn period of an unknown cause.
973
Neurology

05 Nov, 05:46

Subarachnoid hemorrhage SAH

SAH may be asymptomatic

https://youtu.be/wCInmCltl0M?si=f0cjx8iLDavjlRpT

#alteplase #tenecteplase #STROKE #anatomy #subarachnoid #Aphasia #hemorrhage #neuroradiology #Neuropathy #seizure #gene #neuroscience
822
Neurology

05 Nov, 04:18

Case Scenario
A 5-year-old male presented with signs and symptoms of raised ICP, including headache, vomiting, and a decreased level of consciousness

Imaging Description
MRI demonstrates moderate to marked dilatation of the lateral and third ventricles.
There is no trans-ependymal edema, suggesting a chronic course. The fourth ventricle, however, is within normal size. The proximal segment of the cerebral aqueduct of Sylvius is dilated. There is a small membrane below the third ventricle at the distal part of the cerebral aqueduct that is consistent with the aqueductal web (white arrow).

Figure: Serial MRI images of the brain with the following:
(a) axial T2-weighted (T2W),
(b) sagittal T1,
(c) sagittal T1-weighted (T1W) post-contrast,
(d) axial fuid-attenuated inversion recovery (FLAIR),
(e) sagittal T2.

(Figure courtesy of Dr. Samer Hoz)

https://youtube.com/@mohamud_neuropsy?si=3E9B_98e-DXR1ezt

#neurology
885
Neurology

03 Nov, 15:40

Dendrogram summarizing neurologic symptoms and signs.

#neurology
821
Neurology

30 Oct, 20:01

Multiple sclerosis

Three main types of cortical demyelinated #lesions have been described.

1. Leukocortical lesions extend from WM into adjacent cortex;
2. Intracortical lesions are small and centered on vessels;
3. Subpial lesions extend from the pia mater into deeper cortex.
Subpial demyelinated cortical plaques are most common in chronic MS and may span extended distances in the brain. Subpial lesions have a predilection for cortical sulci and cingulate, temporal, insular, and cerebellar cortex. Cortical demyelination can be extensive, with up to 90% of the cortex demyelinated.
It is most prominent in secondary progressive MS and primary progressive MS, suggestive that it may be an important pathologic correlate of irreversible disability and of cognitive dysfunction.

#neurology #sora
1,422
Neurology

30 Oct, 19:33

https://youtu.be/6TrohMqTSB8?si=EMJ1ZNtJvOmj7esD
1,243
Neurology

30 Oct, 00:00

A 69-year-old lady has come in following a sudden onset of dizziness and visual disturbances which started yesterday morning. She initially thought she was just dehydrated however later realised she was unable to read her own shopping list. On the ward round the consultant examines her and finds she is indeed unable to read. She is however, able to write. When she writes a sentence it makes perfect sense, although she is again unable to read it out. She has no problems with her speech, and is able to converse completely normally. She has no motor focal neurological deficit.
1,024
Neurology

29 Oct, 16:12

Side effects of phenytoin

Purple glove syndrome, a rare complication of IV #phenytoin use that typically presents with pain, edema, and discoloration at the injection site that spreads to the distal limb.

Differential diagnosis:
- Intravenous infiltration
- Cellulitis
- Acrocyanosis
- Raynaud's phenomenon
- Livedo reticularis
- Polyarteritis nodosa
- Buerger's disease

https://youtu.be/jmejTDw_UTs?si=nNxHIy1-Iy9ZdsQ-

#neurology
1,173
Neurology

29 Oct, 10:29

Treatment of parkinson's disease

#neurology
1,323
Neurology

28 Oct, 11:57

subacute combined degeneration of the spinal cord (SCDSC)

#neurology
886
Neurology

28 Oct, 07:57

Channel photo updated
0
Neurology

27 Oct, 21:34

Hydranencephaly (HE)

HE is a rare entity that occurs in utero, in which the cerebral hemispheres are completely or almost completely missing which is transformed into a membranous sac filled with CSF , glial tissue, and #ependyma. The cerebellum, midbrain, BG, thalami and choroid plexus are generally not involved.

Hemihydranencephaly is less common disorder characterised by a unilateral absence of one cerebral #hemisphere.

Several aetiologies have been described, but the hypothesis of bilateral occlusion of the supraclinoid segment of the ICAs

Figure ;
Ballooning of the supratentorial and infratentorial compartments resulting in a secondary meningocele through the sutures, elevation of the #tentorium and ballooning of the anterior and middle cranial fossa.

#neurology
1,087
Neurology

26 Oct, 10:57

Failure of normal cleavage of #telencephalon into two cerebral hemispheres results in distinctive anomalies; the milder forms include #arrhinencephaly, in which there is
1. Absence of olfactory bulbs (yellow arrows )
2. Agenesis of corpus callosum

#neurology #embryology
1,130
Neurology

26 Oct, 06:13

Cryptogenic stroke has been hypothesized to be due to:
1. nonstenotic plaque rupture,
2. pAF,
3. underlying malignancies,
4. undefined coagulation
disorders.
Embolic stroke of undetermined source, a subset of cryptogenic stroke, has a defined minimum evaluation required before one concludes there is not an identifiable cause


1. Criteria for diagnosing ESUS
A. Stroke in CT or MRI is not lacunar
B. Absence of extra or intracranial atherosclerosis causing ≥50% stenosis in arteries supplying the area of ischemia
C. No major-risk cardioembolic source of embolism
D. No other specific cause of stroke (arteritis, dissection, migraine/vasospasm, drug misuse)

2. Proposed diagnostic assessment for ESUS
A. Brain CT or MRI
B. ECG
C. Echo
D. Cardiac monitoring for ≥24 h with automated rhythm detection
E. Imaging of the extracranial and intracranial arteries supplying the area of brain ischemia (catheter, MR, or CTA or cervical duplex plus transcranial Doppler)

https://youtu.be/8obatfIOrtE?si=j_Lm4AoaCzrhQtHl
1,163
Neurology

25 Oct, 22:42

Radiomics is defined as the high-throughput extraction of quantitative features that results in the conversion of images into minable data and the subsequent analysis of these data for decision support. The process of radiomics starts with delineating the region of interest, that is, the tumor, in an imaging study and then extracting quantitative data from the segmented volumes and entering them, as well as other clinical and genomic data, into a database. This database is subsequently mined, with use of artificial intelligence, machine learning, and/or statistical analysis, to predict the diagnosis and outcome.

#neurology #radiology
896
Neurology

25 Oct, 19:42

https://youtube.com/playlist?list=PL2XcrMWxPBLSatx3yNt2kmrdNpK_0o3k5&si=QhioVf8mGR0qZs3i
918
Neurology

25 Oct, 18:25

Subarachnoidal cisterns are areas where the subarachnoidal space is widened forming cavities :
1. The cerebellomedullary cistern extends between the cerebellum and the medulla oblongata. The CSF of the fourth ventricle drains through the median aperture and both lateral apertures into this cistern.
2. The chiasmatic cistern is located around the optic chiasm.
3. The interpeduncular cistern extends between the cerebral peduncles and contains the oculo motor nerve (N. III).
4. The pontine cistern is located at the level of the pons.
5. The ambiens cistern surrounds the mesen cephalon except its occipital part and contains the great vein, the posterior cerebral artery, and the superior cerebral artery.
6. The cistern of the lateral fossa arches the lat eral sulcus.
7. The lumbal cistern extends from the medul lary conus (at the lower border of the first lumbal vertebra) till the second sacral vertebra and contains the terminal filum as well as the cauda equina

https://www.youtube.com/watch?v=_yeSkwC6cvk&t=26s
967
Neurology

25 Oct, 08:59

#Baxter’s #Entrapment

It is an entrapment (or compression) of the Inferior Calcaneal Nerve just under the base of the arch of the foot. The Inferior Calcaneal #Nerve is the first branch of the Lateral Plantar Nerve on the bottom surface of the foot. The nerve is also sometimes called Baxter’s nerve, named after the first physician to describe this nerve entrapment as a specific cause of foot pain.

Risk Factors:

Plantar Fasciitis
#Obesity
Flat Foot
Foot Hyperpronation
Muscular Enlargement (such as in athletes)
Bone Spur (Plantar Calcaneal Spur)
#neurology
884
Neurology

25 Oct, 00:14

Treatment of spinal muscular atrophy
878
Neurology

24 Oct, 11:41

Heridetary spastic paraplegia

HSPs are caused by mutations in >80 different genetic loci that ultimately lead to a length-dependent axonopathy of the corticospinal neurons. Therefore, the key clinical feature is progressive lower extremity predominant UMN deficits. HSP mutations also cause mild degeneration of the dorsal columns usually manifest as mild distal vibration loss without spinothalamic tract involvement. Bladder dysfunction is also common. These features can be useful in distinguishing HSP from other genetic myelopathies such as:
1. motor neuron disorders (no dorsal column involvement or bowel/bladder dysfunction),
2. leukodystrophies (usually marked by multifocal neurologic symptoms),
3. spinocerebellar degeneration (usually marked by cerebellar ataxia and sensory involvement).
Although, some forms of HSP, classified as “complex,” can also present multifocal symptoms (e.g., cognitive impairment, seizures, extrapyramidal findings, ataxia, neuropathy, visual impairment), making clinical diagnosis more challenging. Thus, recognizing certain radiographic patterns (e.g., Ear of the Lynx sign) might be helpful to reach the correct diagnosis.
Nonetheless, several of these disorders have overlapping features and ultimately require evaluation by a neurogenetic service before reaching a diagnosis.
1,051
Neurology

23 Oct, 18:46

Pontocerebellar hypoplasia (PCH)

PCH is a heterogeneous group of early-onset #neurodegenerative conditions, affecting but not limited to the cerebellum and pons.
PCH manifest abnormal brain structures to various degrees, with variable impairment of motor and cognitive development.
A typical aspect of all PCH is the predominance of supratentorial symptoms (spasticity, dystonia, chorea), rather than cerebellar symptoms. The absence of cerebellar symptoms is due to the modulating rather than initiating role of the cerebellum in control of voluntary motor function. In severe PCH, cortical functions are impaired together with microcephaly.
The current classification comprises 16 types of PCH based on distinct phenotypes and genotypes.
In most cases, the disease is uniformly fatal early in life. Life span has ranged from death in the perinatal period to 20-25 years. Patients with PCH type 2- have survived to the 2nd and 3rd decades.

#sora #STROKE #neurology #neurologyclinic #seizure #neuroradiology
997
Neurology

23 Oct, 11:06

Parinaud syndrome (dorsal midbrain syndrome)

It is is a rare neuro-ophthalmologic condition that comprises a classic triad of:
1. upward gaze #palsy (from damage to the rostral interstitial nucleus of the medial longitudinal fasciculus and its connections),
2. pupillary light-near dissociation (from involvement of the pretectal and Edinger-Westphal #nuclei or decussating fibers of the pretectal nucleus in the posterior commissure),
3. convergence-retraction #nystagmus (from disruption of the midbrain supranuclear fibers).

Other clinical manifestations
1. diplopia, blurry #vision, #oscillopsia,
2. nausea, #vomiting,
3. ataxia,
4. exotropia, convergence deficiency,
6. #papilledema,
7. bilateral lid retraction (Collier sign),
8. downbeat nystagmus.

The most common etiologies are posterior commissure or pineal gland masses, strokes, and demyelination.
MRI is recommended for diagnosis and management focuses on treating its underlying cause.

https://youtu.be/h23OI_uHIPs?si=7m5lFHcdb-PLRfq3

#neurology
1,115

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