Showing posts with label Neurology. Show all posts
Showing posts with label Neurology. Show all posts

Wednesday, October 25, 2023

Mnemonic | Common locations of Primary Brain Parenchymal Hemorrhage

The Name has the mnemonic in it for the common locations of Primary Brain Parenchymal hemorrhages:

Brain Paren/chyma (divided the word parenchyma by syllable into 2):

Brain = Basal ganglia

Paren = Pons

CHyma = Cerebellum, tHalamus 

I hope it works for you all


Thank you💓

Wednesday, October 18, 2023

Mnemonic | Uncinate Herniation / Transtentorial Herniation

The word that comes first in my mind when i see uncinate written in the book is UNCLE

I don't know why but this is what it is!

so my UnKle is PHD

U = uncinate herniation

K = Kernohan's Notch 

P = posterior cerebral artery compression

H = hemiparesis (ipsilateral)

D  = Duret hemorrhage (midbrain and pons)

  • and from posterior cerebral artery point and hemiparesis, another thing can be linked which is CN# 3 paralysis

because posterior cerebral artery supply mainly occipital lobe so some problem with eye may occur which is actually related to oculomotor nerve compression (just a linker not the actual pathophysiology)

I hope it works for you all again!

In Sha Allah!

Thank you 💓

Tuesday, December 28, 2021

Tuesday, June 1, 2021

Cluster Headache

 Is the cluster headache giving you a headache?

Here's an easy way to remember it.

C-Conjunctival congestion



S-same time, periodicity

T-Tearing of conjunctiva

E-Excess autonomic activity


These clinical features help us to differentiate cluster headache from other types of unilateral headaches.

Treatment includes

1. 100% Oxygen at 10-12L/min for 15-20 mins

2.Sumitriptan 6mg S/c

3. Sumitriptan 20mg and Zolmitriptan 5mg nasal spray


That's it folks!

Happy studying!

Dr. ShilPill

Friday, May 28, 2021

Subarachnoid haemorrhage

Clinically important steps required for SAH management ( from its onset ) 

  • Most commonly due to ruptured saccular (berry) aneurysm
  • Severe & sudden onset of headache different from previous headache pattern or described as "worst headache of my life"
  • Nausea, vomiting, brief loss of consciousness, focal neurologic deficits, or meningismus
  • Noncontrast head CT >90% sensitive within 2-6 hr of SAH onset
  • Lumbar puncture required to exclude SAH definitively in patients with negative CT scan of the head
  • Xanthochromia confirms diagnosis (usually >6 hr from SAH onset)
  • Cerebral angiography to identify bleeding source

Happy studying! 
Thanks folks! 🩺

Tuesday, May 25, 2021

Basal Ganglia Circuit

Hello everyone!  Confusing loop has now simplified look! 👀 

First of all, Basal ganglia receives cortical input, provides negative feedback to cortex to modulate movement.

3 things must be remembered. 

  • SNc (Substantia nigra) input to the striatum via the nigrostriatal dopaminergic pathway releases GABA.
  • Dopamine binds to D1 , stimulating the excitatory pathway, and to D2 , inhibiting the inhibitory pathway. 
  • Pathways from Thalamus to Motor cortex & from Motor cortex to Basal ganglia - “Stimulatory” 

That’s why this circuit is important in voluntary movements and adjusting posture. 

Here is my attempt to simplify this circuit through a drawing. By understanding that you’ll never forget it! 

  • I-N-hibitory pathway goes through Gp-I & N-ucleus(Subthalamic)!
  • If BG output = +, then increased motor activity
  • If BG output = -, then decreased motor activity 

In PARKINSON’S DISEASE, SNc degenerates = lose dopaminergic input to BG
Less stimulation of direct pathway (⬇️gas) and less Inhibition of Indirect pathway (⬆️ brake) = overall indirect wins =less motor activity. This explains bradykinesia and rigidity of PD but not tremor. 

STN and GPi are targets of Deep Brain Stimulation in PD. 
Deep brain Stimulation INHIBITS activity in these structures—inhibiting either would lead to decreased inhibitory output of BG = increased motor activity-> improve PD symptoms. 

Lesion of STN -HEMIBALLISMUS= uncontrolled erratic large amplitude movements on one side.  Why INCREASED movement with STN lesion? 
By decreasing STN excitation of GPi we essentially ‘remove’ indirect pathway from equation, and direct pathway becomes unchecked -> ⬆️ movement      

Thank you! 🩺

Thursday, May 13, 2021

Levetiracetam - pregnancy considerations


Levetiracetam, used primarily for seizures control, is also used off-label for SAH, status epilepticus, seizure prophylaxis in craniotomy and traumatic brain injury.

Dosing is increased in pregnancy and closely monitored regularly due to various physiologic effects, especially in third trimester. (levitate dose of levetiracetam) :-

- increased volume of distribution, Vd (increase in plasma volume, CO)

- increased renal excretion (increase in GFR; levitate the rate)

- rapid and almost complete absorption via GIT  (unlike other drugs with decreased absorption in pregnancy)

- low risk of adverse effects and fetal malformations when used in monotherapy. (low with mono, high with poly)

- Levetiracetam is NOT metabolized by liver; Cyt P450 independent. Bioavailability 100%. (unlike other antiepileptics - hepatic metabolism increases in pregnancy)

Levetiracetam crosses placenta and can be detected in the newborn. (leve leaves mother)

The newborns are at greater risk of SGA and low APGAR score.

Protein-binding of the drug is low (<10%). So, decrease in albumin concentration during pregnancy does not significantly affect the drug concentration. (low pro)

That's all

- Jaskunwar Singh

Tuesday, May 11, 2021

Toxoplasmosis classic triad mnemonic


Toxoplasmosis classic triad in neonates mnemonic: CATS 

- CAlcifications (intracranial)

- Tension hydrocephalus

- See (Chorioretinitis)

Also, check out this video mnemonic by IkaN

- Jaskunwar Singh

Sunday, May 9, 2021

Management of asymptomatic carotid atherosclerotic disease and carotid artery stenosis mnemonic

Super short post!

A) Asymptomatic

≥80% stenosis: Carotid endarterectomy
≤79% stenosis: Medical management

Mnemonic AGES: Asymptomatic Greater than Eighty Surgery

B) Symptomatic

≥70% stenosis: Carotid endarterectomy

Mnemonic SSS: Symptomatic Seventy Surgery

50%-69% stenosis
Male: Carotid endarterectomy
Female: Medical management

Mnemonic MMM: Males Manage More than fifty with surgery

<50% stenosis: Medical management

That's all!

Monday, April 26, 2021

Menkes disease and Wilson's disease - DDx


Okay so maybe they are the two of the options for a patient's clinical scenario question and you have a blurred memory for which is which in context to copper metabolism?

Let's clear the basic facts here...

Wednesday, April 7, 2021

DWI-FLAIR Mismatch on MRI for Unclear-Onset Strokes

Diffusion-Weighted Image (DWI) and Fluid-Attenuated Inversion Recovery Image (FLAIR) Mismatch on MRI can be used as a surrogate for the time of stroke onset for unclear-onset strokes or "wake up" (nocturnal) strokes.


Sunday, February 28, 2021

Essential tremor - a mnemonic.

Do you often forget the features of 'essential tremor'? Well shake no more, 'coz here's a mnemonic that will straighten things up for ya!

Wednesday, January 27, 2021

Topiramate mnemonic

How I remember that the anti-epileptic drug (AED) topiramate is associated with kidney stones:
To-pee-ra-mate can cause you "to pee rocks, mate." Rocks = stones, pee = urine.

How I remember that the AED topiramate is associated with mild cognitive impairment:
toPIRAmATE can make you a "pirate" and make you forget "Tom"! (This one is a stretch but can work lol)


Wednesday, January 20, 2021

Anti-epileptics in pregnancy mnemonic

 The choice of antiepileptic drugs for women with epilepsy of childbearing age who are planning a pregnancy are

Saturday, December 12, 2020

COVID-19 and the increased risk of Parkinson's disease


Currently posted in psychiatry, I was reading articles on Parkinson's disease and came through this important finding in context with the coronavirus disease.