A Neurology Case Discussion

Hey guys, let's ponder upon the following case.
Before reading this case, just know that this is a case of cerebellar tumor. Now try to localize the tumor in the cerebellum by taking help of the symptoms of this kid. This will help you in the differential diagnosis given later.

A 4 year old complains of headache, drowsiness and occasional diplopia; he is unsteady on his feet with frequent falls. Examination demonstrates truncal ataxia, sometimes accompanied by incoordination of the limbs; variable ophthalmoparesis and papilledema on fundoscopic examination.

Any guesses on what this could be?

Ok so here goes the case discussion:

Medulloblastoma typically presents with a midline cerebellar syndrome, with hydrocephalus and resultant increased intracranial pressure.
Clinically, it can be distinguished from ependymoma involving the fourth ventricle by the early appearance of nausea and vomiting in the latter, due to involvement of area postrema. Cranial nerve palsies may appear with either tumor, and increasing intracranial pressure is typical of both.
The predominance of signs suggesting primary involvement of vermis distinguishes medulloblastoma from cystic or solid astrocytoma of the cerebellum which typically involves a cerebellar hemisphere rather than the vermis. Although rarely there are midline midline astrocytomas.

You are awesome if you were able to get this one right. :)

-VM

Fact of the day: Genesis of the U wave

Hey guys!!

As you know the U wave in the ecg is seldom seen especially in leads V2 and V3 physiologically especially during bradycardia.
And it is seen pathologically in Hypokalemia.

So how is it generated?
If you are thinking due to repolarization of papillary muscles, let me tell you that this hypothesis is now obsolete.

There are three trending theories at present trying to explain it:

1. Delayed repolarization of the subendocardial Purkinje fibres.

2. Prolonged repolarization of the midmyocardium ( M cells)

3. After-potentials resulting from mechanical forces in the ventricular wall.

That's it!

-VM

Fact of the day: Citrobacter causes brain abscesses in neonates

Citrobacter species are Gram-negative enteric bacilli found in the intestinal tract of humans and animals, and are also present in soil and water.

Why does cyanotic heart disease predispose to brain abscess?

Ever wondered why cyanotic heart disease predisposes to brain abscesses?

Step 2 CK: Treatment of Multiple Sclerosis and mnemonics!

Hello!

This post is all about treatment of Multiple Sclerosis.

Creutzfeldt jakob disease mnemonic

Here's one on Creutzfeldt jakob disease :D

Picks disease mnemonic

Hello!

After my infinite struggle, I think I have finally found a way to remember it :D

Percutaneous endoscopic gastrostomy.

Hello awesomites let's know about PEG .

PEG stands for Percutaneous Endoscopic Gastrostomy .We normally use PEG tube .
also known as Feeding tube,Esophagogastroduodenoscopy  tube.=P

In simple language PEG is method of placing a tube into the stomach percutaneously followed by endoscopy .
Tube is passed into a patient's stomach through abdominal wall .
It is preferred route of nutritional support in patients having dysphagia or in unconscious patients.
It offers superior exposure to GI systems.
Most of the PEG tube has mushroom shaped device at the end that holds it in the stomach and prevent it from falling .If it falls do not wait till next day the hole may heal and this may create complications.

Whereas PEG  is also contraindicated in:-
-Distal enteral obstruction.
-Hemodynamic instability.
-Severe ascites.
-Sepsis
-Severe Gastroparesisi.
-Thrombocytopenia.

Scoliosis

Hello awesomites !It's been long time that I haven't written anything due to exam pressure =). Let's start with today's simple topic.

What is scoliosis?

-It's a disorder in which spine has sideways curve like "C" or "S" .It may increases or remain same.Patient usually suffers from breathing problems ,constipation due to tightened organs.
-Factors causing scoliosis are mainly genetic though environmental factors may cause scoliosis.
-Diagnosis is mainly by Plain X-ray.

Treatment?

-Current methods requires surgery to adjust growth rods every 6 months .This may require 8 to 10 procedures in total.

What is MAGEC rods ?

-MAGnetic Expansion Control rods are used as non-invasive adjustments.
Surgeons can lengthen the rods using a Handle-held external magnet.It takes 15 minutes and is performed every 3-6 months .It is also cost effective.Once a surgeon implants the device it's easy to use by remote.
MAGEC is used in children's (normally under 10 age) with severe spine deformity .

Stay awesome:)

~Ojas

Rheumatoid Arthritis deformities : Mnemonic

Hi everyone. This is just a mnemonic post on RA deformities.

So there are 2 important deformities that are definitely seen clinically but are hard to remember.
The Boutonniere and the Swan neck deformities both occur as some defect at 3 joints :
The Proximal Interphalangeal Joint (PIP)  and the Distal Interphalangeal Joint (DIP) and Metacarpophalangeal Joint (MCP).

So Remembering one of them is sufficient as the other one would be the exact inverse.

Remember :

Bout.on.ni.e.re

So Out one Ex .
Which means there's extension at DIP (the outer joint). Now after extension , alternate the next joint with flexion ( so Flexion at PIP ) followed by extension again ( so extension at MCP )

So , Boutonniere is -
DIP - Extension (out one is ex)
PIP - Flexion
MCP - Extension.

And Swan neck would be the opposite :
DIP - Flexion
PIP - Extension
MCP - Flexion

Hope this helped !
Stay awesome.

~ A.P.Burkholderia

Fact of the day: Tugging on heart strings

Hey Awesomites

Since its Valentine's day, here is a love fact you need to know:

Emotional instability and stress associated with constant anxiety (in case you are suffering from I-love-you-penia or broken-heart syndrome) may actually lead to acute emotional trauma to the heart and result in rupture of heart strings, the "chordae tendineae".

The chronic negative effects on heart are associated with Takotsubo cardiomyopathy, aka broken heart syndrome which involves weakening of myocardial muscles and rupture of chordae tendineae leading to right sided heart failure, ventricular arrhythmias and rupture.

So ease your suffering by talking to the love of your life on this special day and confess about your feelings today. <3

Source- Tumblr

Ps- Medicine loves you and cares for you <3
- Jaskunwar Singh

Soap bubble appearance on X ray:Differential diagnosis

Hello everyone!
I always find X rays quite confusing especially when they appear same.
It's a short post about differentiating bone tumors.

Soap bubble appearance on X ray is expansile, eccentric vaguely trabeculated space having thin sharp defined sclerotic margins.
Mostly seen in bone tumors and other bone lesions.
On X ray they all appear same, only way to differentiate them is to know their location and other associated factors.
Commonly seen in
1) Aneurysmal bone cysts-
  Location of ABC is Metaphysis.
It occurs in younger age group i.e less
than 20 years. So the X ray of such
patient will have non fused and 
immature bone.
Preferred sites are long bones of upper and lower limb, especially femur.

2) Giant cell tumor(osteoclastoma) -
Location of GCT is epiphysis
Here the prevalent age group is 20-40, which means an adult sketetal structure.
While the preferred sites are same like ABC.
So if one see epiphyseal lesion with soap bubble appearance in mature bone, it has to be Giant cell tumor.
GCT presents with other classical signs of Egg shell crackling on palpitations.
Giant cells on histology.
Which are NOT the tumor cells. So its one of the example of misnomers. They are meant to misguide you.

Thats it :)
Stay awesome

-Khushboo

Pharmacology: Microsomal metabolism by CYP enzymes in phase 1 mnemonic

Thanks a lot for this video, Shilika!

Pharmacology: When dialysis is not the treatment mnemonic

Video by Shilika!

Fact of the day: 'Experience- taking' from books

Today's fact is relatable for all medicos and books lovers <3

Yes, you can subconsciously take on the attributes of your favourite fictional characters when reading a story- not just the thoughts and beliefs of the character, but the whole state of being itself.

Well, it is more often seen in those who are depressed or who don't have much life experiences of their own.

Also, if the reader is able to relate experiences in the life of character of the story, he might take it to his own life and adopt the mindset and perspective of the character. This may lead to temporary or permanent changes in his real life.

Excessive openness to experiences may lead to schizotypal, narcissistic or paranoid personality disorders among others.


Happy reading :D

- Jaskunwar Singh

Fact of the day: Handedness arises from genes in the spinal cord

Handedness is an asymmetry arising due to left-right differences in the development of nervous system. Evidences suggest that a human embryo of eight weeks is able to move its right arm more than the left arm.

Well, if you know something about neurologic development in-utero, you must know that at eight weeks signals are not transmitted from the brain yet. Instead the signals travel from the spinal cord.

The left side of the cord matures faster than the right cord. This means the genes that control growth and development are activated faster on the left cord than the right one. In the hindbrain, it is the other way around.


That's all
- Jaskunwar Singh

Brucellosis and it's reservoirs mnemonic

Hello!

Here's a mnemonic on Brucellosis and it's reservoirs! :)

Catalase positive organisms mnemonic

Hello!

Here's a mnemonic on Catalase positive organisms :)

Video by Huzaifa Bhopalwala

Enzymes requiring thiamine mnemonic

Can you enlist the enzymes requiring thiamine?

If you can, give yourself a pat on the back and don't read further.

If you can't, give yourself a pat on the back, because you are going to learn how to remember it! :D

Causes of elevated JVP mnemonic

Hey Awesomites

Jugular vein is on a high and stretching out on the RAPs of  "the CREST" .. wohhooo.. :D

R- Right ventricular failure
A- Atrial septal defect (with mitral valve disease)
P- Pericardial compression/ tamponade

C- Circulatory overload
R- Renal failure
E- Excess fluid administration
S- Superior vena cava obstruction
T- Tricuspid stenosis


Hope you enjoy the crest too ;p

- Jaskunwar Singh

Difference between Caput Succedaneum and Cephalhematoma

Hello everyone!
Lemme tell you the difference between Caput Succedaneum and Cephalhematoma today! :)

Bishops score and Manning score mnemonic

Another video by Shilika!

Immunohistochemistry and cytogenetics for leukemias: Part 2

Here's part 2! On Chronic myeloid, chronic lympoid and MDS!

Immunohistochemistry and cytogenetics for Non Hodgkins Lymphoma

Hello!

The Romberg's test does not test cerebellar function

The Romberg's test does not test cerebellar function.

This is a topic that most medical students discuss at some point of time. I have found myself in the midst of similar conversations over my years at medical school.

After much study, I happened to reach an understanding that clarified the purpose of the test and provided a way to understand the results as well.

It would help if you think of the cerebellum as a processor (such as a C.P.U. in a computer).
There are 3 main inputs:


Romberg's test (3 steps):
1. Ask patient to stand with feet together.
2. Ask patient to close both eyes.
3. Maintain the posture for 60 seconds.

The Romberg's test is positive if the patient cannot stand for 60 seconds with feet together and eyes closed.

It is essential to understand that without the processor, the inputs do not matter (as there will be no output and no result).
Thus in Cerebellar ataxia, the patient will be unable to perform any of the above 3 steps and thus the Romberg's test cannot be performed on this patient.

In a situation where the cerebellar function is intact and Romberg's test is performed:
The first input (Vision) is lost when the eyes are closed.
It is now unto the 2 other pathways (Proprioceptive and Vestibular pathways) to provide input to the cerebellum.

Thus the Romberg's test will be positive in cases of:
1. Proprioceptive dysfunction e.g. Sensory peripheral neuropathy & Dorsal column dysfunction
2. Vestibular dysfunction e.g. Vestibular neuritis

This was my attempt to provide a brief summary about this topic and it has been compiled to the best of my understanding. Please feel free to discuss it further, in the comments section below.

Have a great day!

- Vikramjeet Kakade

Immunohistochemistry and cytogenetics for leukemias: Part 1

Hello!

Fact of the day: Most efficient sleep position to clear the brain of waste

Your sleep position at night matters a lot. Not head-up, nor head-down, but sleeping on your side is the most efficient position to clear waste materials from the brain.

This is because the glymphatic system (exchange of CSF with the interstitial fluid to get rid of damaging brain proteins) of our brain works most efficiently in lateral position compared to supine or prone position.

Lateral position and right posture while sleeping is considered advantageous for those suffering from neurologic and psychiatric disorders due to this reason.

That's all

- Jaskunwar Singh

Spermatic Cord contents : Mnemonic

Hello. This is about the things that your thing contains if you're a guy :p

So the spermatic cord is an important content of the inguinal canal in men.

And it contains a host of things.

Remember :

Plenty of Dick Contributes To Good Sex Life

Plenty of = Pampiniform plexus
Dick = Ductus Deferens
Contributes = Cremasteric artery
To = Testicular Artery
Good = Genitofemoral Nerve (Genital br)
Sex = Sympathetic plexus
Life = Lymphatics.

So it's 3 Arteries + 2 nerves + 3 other things.

Hope you like this !
Stay awesome.

Fascia of the thigh : Mnemonic

Hi everyone. This is a short post where I tell you about the thigh fascia.

So fascia of the thigh is super important during surgery , and we are expected to know its layers.
So it's got 2 layers : Camper's and Scarpa's.
Now which is outer and which is inner ?

Remember :

OC IS  good.

So OC = Outer Camper
       IS  = Inner Scarpa

Hope you liked this!
Stay awesome.

Schistosoma mansoni and Schistosoma haematobium mnemonic

Here is the video :)

East African Sleeping Sickness and West African Sleeping Sickness mnemonic

Here is the video :)

Naked RNA viruses mnemonic

Here is the video!

Side effects of anti-glaucoma drugs mnemonic

Here's the video!

Bacteriophages coding for toxins mnemonic

Video is up :)

Naked DNA viruses mnemonic

Here is the video!

Uses of tetracyclines mnemonic

Write Tetracycline as TetraCycLyne -

Fact of the day: Most common causes of non gonococcal urethritis

MCC of NGU in decreasing order are:

Dermatophytes mnemonic

Let's learn a lil mycology today!

Lesions of small pox and chicken pox mnemonic

Same stage vs different stages of development!

Structure and properties of poxviruses mnemonic

Hello!

So we will be learning about the structure and multiplication of poxviridae today from the mnemonic: “Pox is in a big box”

Excited?

Memory aid for urease positive organisms

Hailo!

Here's a little memory aid for urease positive organisms.

Alcohol and Drug Interactions: 4th Part

Hii friends...

This is the last post in the series: Alcohol and Drug Interactions. The previous posts in this series were Disulfiram-like Reaction, 2nd Part, and 3rd Part.

With Warfarin

1. Binge drinking- Leads to inhibition of warfarin metabolism by CYP450 enzyme system. So it can precipitate warfarin toxicity with increased bleeding tendency in the body.

2. Chronic Alcohol consumption- Leads to induction of CYP450 enzyme system, so increases metabolism of Warfarin in the liver. So higher than usual dose of warfarin is needed to exert appropriate anticoagulant action in the patient.

With Opioids

Alcohol increases the sedative effects and also increases the risk of respiratory depression. It also attenuates cough reflex and gag reflex, so the patients have a higher risk of getting food stuck in their respiratory tract, remember Cafe Coronary.

With NSAIDs

1. NSAIDs have been implicated in an increased risk of ulcers and gastrointestinal bleeding in elderly
people. Alcohol may exacerbate that risk by enhancing the ability of these medications to damage the
stomach mucosa.

2. Alcohol also potentiates the antiplatelet actions of Aspirin, hence increase the risk of bleeding in the patients.

3. Intake of alcohol with acetaminophen can increase the risk of acetaminophen-related toxic effects
on the liver. Acetaminophen breakdown by CYP2E1 (and possibly CYP3A) results in the formation of a toxic product(NABQI) that can cause potentially life-threatening liver damage. As mentioned earlier, heavy alcohol use enhances CYP2E1 activity. In turn, enhanced CYP2E1 activity increases
the formation of the toxic acetaminophen product. In people who drink heavily or who are fasting
(which also increases CYP2E1 activity), liver injury may occur at doses as low as 2 to 4 grams per day.

That concludes this series. I hope it will help you to guide your patients towards drinking alcohol more judiciously. :p

-VM

Alcohol and drug interactions: 3rd part

Hey, guys.....

This is the third post in the series, Alcohol and drug interactions. The other posts are Disulfiram-like Reaction, 2nd Part and 4th Part.

With Antihistaminics

Alcohol increases the risk of sedation, drowsiness and falls, especially in the elderly population and with the 1st gen antihistaminics.

With Barbiturates and Benzodiazepines

Alcohol acts synergistically with them to increase their sedative effects and memory-impairing effects( This memory-impairing effect is misused in Date Rape drug, Flunitrazepam(Rohypnol)). Besides it also inhibits their metabolism in the liver, hence, increasing the drug's levels in the blood.

With H2-Receptor Antagonists

These agents(eg., Cimetidine, Ranitidine) inhibit the action of Alcohol dehydrogenase(ADH) present in gastric mucosa.  Cimetidine may also increase the rate of gastric emptying hence increasing the absorption of alcohol. So both of these effects contribute to increasing the Blood Alcohol levels.

With Muscle Relaxants

Several muscle relaxants (e.g., carisoprodol, cyclobenzaprine, and baclofen), when taken with alcohol, may produce a certain narcotic-like reaction that includes extreme weakness,
dizziness, agitation, euphoria, and confusion. For example, carisoprodol is a commonly abused and readily available prescription medication that is sold as a street drug. Its metabolism in the liver generates an anxiety-reducing agent that was previously marketed as a controlled substance (meprobamate). The mixture of carisoprodol with beer is popular among street abusers for creating a quick state of euphoria.

That's all!

-VM

Alcohol and Drug Interactions: 2nd part

Hey guys,

This is a continuation of the previous post on Disulfiram-like Reaction.

Let us start with a basic info. Pharmacokinetic drug interactions with alcohol are only seen in heavy drinkers whereas Pharmacodynamic drug interactions can be seen in moderate drinkers and even after a single episode of drinking. 

With Antibiotics

As already mentioned, the Disulfiram-like reaction can occur with Isoniazid, Cefotetan, Cefamandole, Cefoperazone, Chloramphenicol, Sulfamethoxazole, Sulfisoxazole.

Besides patients on Isoniazid should abstain from drinking alcohol since isoniazid is hepatotoxic and the liver damage can be exacerbated by concurrent alcohol consumption

With Antidepressants

1. With TCAs: Alcohol increases the sedative action of TCAs, especially Amitriptyline, Doxepin etc.
Alcohol also impairs the first-pass metabolism of Amitriptyline in the liver causing increased bioavailability of the drug. Excessive increase in levels of TCAs in the blood can precipitate convulsions and cardiac arrhythmias.

2. Among SSRIs, all are relatively safer with alcohol; the safest being Fluoxetine.

3. With MAOIs(eg., Phenelzine, Tranylcypromine): There can be severe high BP(cheese reaction) if taken together with red wine which contains Tyramine.

That's all! :)
Do go through the subsequent posts in this series, 3rd Part and 4th Part.

-VM

Alcohol and Drug Interactions: Disulfiram-like Reaction

Hey, guys...

So day before yesterday, there was my Forensic Medicine viva and the examiner asked me the causes of impotency. And I immediately started blabbing about Stress, Phimosis, Hypospadias, Peyronie's disease, I even mentioned Parkinson's disease. The examiner interjected me and asked the most common cause. I guessed heart disease and the related medications and he denied. Then he said it is excess consumption of alcohol and asked me not to underestimate alcohol and it's various interactions and correlations ever.
So here I am, trying to summarize the interactions of alcohol with the major classes of drugs.

Disulfiram-like Reaction

I am not going to go into the details of the mechanism. Just, in brief, Disulfiram-like reactions entails flushing(due to dilatation of blood vessels), nausea, vomiting, sweating, hypotension, so reflex tachycardia which can be deleterious to a patient of coronary artery disease(CAD).

Now let us try to use CAD as a mnemonic here while learning certain other things as well.

1. It starts with C, a lot of drugs starting with C have this reaction, like Cefamandole, Cefoperazone, Cefotetan, Chloramphenicol.

2. Patients with CAD have Pain, so let us now manage that some analgesics starting with P(for Pain), Phenylbutazone, Phenacetin.

3. Patients with CAD can have attacks of Angina, for which we give Nitrates, so let us take that. Drugs with Nitro group: Nitroglycerin, Isosorbide dinitrate, Nitrofurantoin, Metronidazole. Why leave Sulpha group behind?
Drugs with Sulpha group: Sulphamethoxazole, Sulfisoxazole.

4. CAD often co-exists with Diabetes Mellitus(DM). So let us manage that with some Sulfonylureas; Tolbutamide, Tolazamide, Chlorpropamide and even the 2nd gen drug Glyburide.

5. Patients with DM are immunosuppressed. Hence, they are predisposed to Mycoses and TB. Manage them with Griseofulvin and Isoniazid respectively.

That's all! :)
Do go through the other posts in this series, 2nd Part, 3rd Part, and 4th Part

-VM

Vibrio species: Halophilic and non halophilic vibrio mnemonic

Anyone up for a lil microbiology?

Non tubercular uses of: Streptomycin

Another super short video :)

Non tubercular uses of: Rifampicin

Super short video :D

Anticonvulsants: Inhibitors and inducers of CYP450 mnemonic

Although we have a text post on this... Let's upload a video too! :D

Pharmacology: Drugs causing hemolysis in G6PD deficiency

Here's Shilikas first video :)