Nirmal Pandey MD DM Neurologist
@nirmalregency
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π π π ‘π π π £π π ‘ Regency Health SGPGIMS | PMCH | BSMC Alum πΎππππππππππ ππ ππππππππ | πππ₯π€π ππππ ππ₯ ππππ€πππ
Kanpur, India
Joined June 2010
Like to present a case seen in 2017. We were not aware of the entity then. 17F, 15D vomiting, headache. No deficit. Evaluated at institute. Extensive blood/CSF/tropical diseases workup -ve. CSF: P81, G57, cell 30 (all L). IVMPS x 5gm. Discharged with Dx of ADEM. 1st CEMR. (1/8)
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Another one:.
This case highlights neurosyphilis' mimicry of neoplasms, emphasizing the need to integrate epidemiologic risk and serologic/CSF screening in atypical intracranial lesions: #NeuroImage #NeuroTwitter
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An ποΈ opening π§΅post that made my Bellβs palsy learning complete today. Great.
#IDtwitter.#MedTweet.#NeuroID.π§΅A man walks into neurologyβ¦ with facial palsy. Again. Same MRI findings. Same treatment. Still no clue. Until one detail flipped the scriptβand I had my βwait, WHAT?!β ID moment. A thread ππ§ π.
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Point to be discerned: Not all restricted-diffusion lesions of corpus callosum's are CLOCC.
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It is not so very common. We do see them anecdotally once in 2-3 months. And that is when I am pally with our radiologist. Where I get to see the other consultants' patients' MRI. Present in 0.5β3% of all brain MRIs done for encephalopathy, seizures, or systemic illness.
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Starkey @jaystarkeymd in 2017 had coined this term, defined it, and postulated its pathophysiology. 7|7
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#ChatGPT has helped us to make a relative frequency chart of the reported cases from the literature. NB: The actual frequency can vary by population, age group and geographic distribution. This list is ordered from most to least commonly reported in literature and case series.
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What are the common associations with CLOCC?. Here is an broad list with few examples of each. Individual causes are very many. 5|7
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Do you want to modify the definition of CLOCC?. 1. Yes. If so, what changes you want to make?. 2. No. It is perfect, given the current understanding. 4|7.
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You guessed β
. This is CLOCC. Can be seen with ADEM & AIE too. How can we define CLOCC?.CLOCCs are non-enhancing, diffusion-restricted lesions, seen on MRI, typically centered in the splenium, that are usually reversible and reflect a stereotyped brain response to various
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What is the diagnosis ?. 1. ADEM.2. Infarct.3. CLOCC.4. Autoimmune encephalitis. 2|7.
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β¨ Sunday Rejuvenation β¨. 11β. Known case of epilepsy being treated as focal onset. Reassessed as being a case of IGE. While ASMs were being transitioned he developed a flurry of seizures. Non contrast MR brain π.T2|FLAIR normal. a short π§΅. 1|7
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Never knew Ketamine had tablet formulations too. It is never too late to learn.
nature.com
Nature Medicine - A phase 2 dose-finding study of an extended-release tablet formulation of ketamine in patients with treatment-resistant depression shows that this formulation overcomes many of...
What if patients with treatment-resistant depression (TRD) could be treated at home, with a ketamine tablet?. A 12-week international trial tested this possibility using a new extended-release ketamine formulation (R-107) in outpatient settings (Glue et al, 2024). Hereβs the
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One from our closet. COX20-associated mitochondrial disorder. The commonest presentation is early childhood onset sensory predominant severe axonal neuropathy.
Let us learn something different today. 9β. Hindu. Born of consanguineous marriage (pedigree chart π). 1 year, gradually progressive gait ataxia w/ mild dysarthria. βDTRs. NB: I am not a geneticist. #neurotwitter #NeuroX #MedTwitter #MedX #Neurology #FOAMmed #Genetics .π§΅.
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Share a neurology case you have seen only once in your lifetime and will never see again.
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This is a milestone post on cranial nerve imaging. I have bookmarked it. Refer to it once in a while. Awesome.
Imaging Quick Tips & Tricks for Cranial Neuropathies π§ . A neuroimaging 𧡠on check areas and pathology. #neurology #meded #medicine #neurosurgery #ent #radres #futureradres @AlbanyMedRadRes @PennRadiology
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Neuro-SjΓΆgrenβs. I have not experienced most of them. Have you?.
𧡠Neuro-SjΓΆgrenβs: Beyond Dryness. SjΓΆgrenβs Syndrome isnβt just sicca. When nerves get involved, it can be devastating β and often misdiagnosed. Hereβs a deep dive into neurological manifestations of SjΓΆgrenβs Syndromeπ. #Rheumatology #NeuroSjΓΆgren #MedTwitter
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pH & chloride normal. So SjΓΆgrenβs was a wild card.
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This was todayβs hypoPP. But SjΓΆgrenβs negative.
We neurologists always check for SjΓΆgrenβs syndrome in patients presenting with hypokalemic paralysis (due to distal RTA). The positive pick rate is quite high.
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We neurologists always check for SjΓΆgrenβs syndrome in patients presenting with hypokalemic paralysis (due to distal RTA). The positive pick rate is quite high.
𧡠Thread: The History of SjΓΆgren Syndrome β From Dry Eyes to Autoimmunityπ. @elisa_comer @NeuroSjogrens @SjogrensForum @SjogrensOrg @SjogrensCa @CatSjogren @SarahSchaferMD @IhabFathiSulima @DrAkhilX @nirmalregency #MedTwitter #RheumTwitter
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