Yong Chuan Chee @CyChuan

A patient with isolated peripheral nerve vasculitis developed reversible bilateral hypoglossal palsy and tongue atrophy, with resolution of bulbar symptoms following immunosuppressive therapy and reinnervation, a rare neurological outcome. ja.ma/3SeBQWx

Further limbic anatomy

Tonic-clonic seizures captured during ambulatory video-EEG are frequently unreported dlvr.it/TT8Q4y #Neurology #Epilepsy

✅Giant cell arteritis–related anterior ischemic optic neuropathy (GCA-AION). 💡The MRI finding is the “central bright spot sign”, representing optic nerve head enhancement. It likely reflects ischemic-inflammatory injury of the posterior ciliary circulation. dx.doi.org/10.3174/ajnr.A…

⏰️Time is Brain 🧠 in MOGAD! Early and Effective acute treatment impacts disability and long-term outcomes. Start and escalate quickly if poor response. Tocilizumab also useful in severe attacks! @NeuroinmunUC @TheMOGProject @TheSumairaFDN tandfonline.com/eprint/FDSWURI…

The Nerve That Told the Story: A Missed Diagnosis Hiding in Plain Sight Case details 🔸A 40-year-old woman walked into my clinic after a year of suffering. It had started with tingling, burning pain, and numbness in her left foot. Over the next year, the symptoms spread to the right foot and eventually to both hands. Sleep became difficult. Daily activities became exhausting. Most importantly, she had begun to lose hope. 🔸She had already consulted several doctors, including neurologists. Blood tests were largely unrevealing. Nerve conduction studies showed an asymmetric axonal neuropathy, a pattern that suggests damage to individual nerves rather than a typical length-dependent neuropathy. 🔸She had been treated with vitamin B12 supplements, gabapentin, and pregabalin, but the relief was only partial and temporary. 🔸During examination, one finding stood out: Thickening of the left superficial peroneal and sural nerves. Surprisingly, her skin was completely normal. This was important because many people, including some healthcare professionals, still associate leprosy exclusively with skin patches. ✅A nerve biopsy was performed. The result was revealing: Leprosy-related neuropathy (borderline lepromatous leprosy). The biopsy showed inflammation, foamy macrophages, acid-fast bacilli, and severe nerve fibre loss, confirming the diagnosis. Suddenly, the story changed. After a year of uncertainty, there was now a treatable cause. She could begin appropriate multidrug therapy and receive interventions aimed at preventing further nerve damage. 🔸Leprosy remains endemic in India, which continues to report the largest number of new cases globally. Importantly, pure neuritic leprosy, where nerves are affected with little or no skin involvement, is well recognised in India and may account for a significant proportion of cases seen in neurological practice. 🔸This case highlights a timeless lesson in medicine: Sophisticated tests are valuable, but careful clinical examination remains indispensable. Sometimes, the diagnosis is hidden not in the laboratory, but beneath the examiner's fingertips. A thickened nerve can tell a story that no blood test can. Dr Sudhir Kumar @hyderabaddoctor

A patient has had 3 TIAs since morning. This is not a TIA patient. This is a stroke waiting for permission. 🚨 CRESCENDO TIA Management 1️⃣ Stop calling it low-risk. Recurrent stereotyped TIAs = neurological instability. 2️⃣ Don't calculate. Don't reassure. ADMIT. 3️⃣ Don't just image the brain. Image the ARTERY. CTA head-neck often changes management more than another neurological examination. 4️⃣ Ask one question: WHY is the brain repeatedly losing blood flow? The usual suspects: 🔴 Symptomatic carotid stenosis 🔴 Intracranial stenosis 🔴 Cardioembolism (AF/LV thrombus) 🔴 Free-floating thrombus 🔴 Capsular warning syndrome 5️⃣ Treatment follows mechanism. Carotid culprit? → Think urgent carotid intervention. Intracranial stenosis? → Aggressive medical therapy. AF? → Anticoagulation pathway. 6️⃣ Common mistake: Treating BP numbers instead of brain perfusion. In hemodynamic TIAs, over-lowering BP may worsen the problem. 7️⃣ Commoner mistake: Symptoms have recovered. The symptoms recovered. The mechanism did not. My bedside rule: A crescendo TIA is not a warning bell. It's the stroke already knocking on the door. Your job is to find which door: Carotid. Intracranial. Cardiac. Thrombus. Perforator. #Stroke #Neurology #TIA #StrokeMedicine #NeuroTwitter #MedTwitter

43 year old woman with dizziness, hiccups, nausea. MRI shows THIS lesion in the medulla! anti AQP4 neuromyelitis optica? No! Hint: her father has progressive gait decline and motor/sensory neuropathy. Diagnosis?

After a very long hiatus, we are back at uploading lectures to our YouTube channel. Check this one out by Dr. Frauscher @AnphyLab #NeuroX #SEEG #EpilepsySurgery Trends and Innovations in SEEG (Birgit Frauscher, MD, PhD) #Epilepsy #Ep... youtu.be/GhrE-cuZ8-g?is… via @YouTube

Many patients with vestibular injuries (Unilateral/Bilateral) develop a hardware glitch that leads to their ongoing dizziness - this infographic reviews how this leads to a software glitch and the need for VRT.

The biggest takeaway from the ICTRIMS Friday & Saturday sessions: The most important treatment in neuroimmunology is not a drug. It is getting the diagnosis right at the first attack. A few pearls I am taking back to my clinic: • Bilateral optic neuritis is MOGAD/NMOSD until proven otherwise. • Every LETM deserves AQP4 and MOG antibody testing. • Disc edema in optic neuritis is a diagnostic clue, not merely an examination finding. • Severe NMOSD attacks should trigger early consideration of plasma exchange. • A positive MOG antibody without the appropriate clinical syndrome is not MOGAD. • CIDP with tremor, sensory ataxia, root hypertrophy and poor IVIg response should raise suspicion for paranodal disorders. • Steroid responsiveness is not a diagnosis. What struck me most was this: We are moving from diagnosing MRI lesions to diagnosing disease biology. The clinician who recognises the phenotype before the antibody report arrives will often make the greatest difference to the patient’s future. That difference may mean preserved vision instead of blindness. Independent walking instead of wheelchair dependence. Recovery instead of lifelong disability. Excellent learning and thought-provoking discussions over the last two days at ICTRIMS. #ICTRIMS2026 #Neuroimmunology #MultipleSclerosis #MS #NMOSD #MOGAD #AutoimmuneNeurology #Demyelination #Neurology #NeuroTwitter #MedTwitter #MedicalEducation

A valuable learning from #ICTRIMS2026: In neuroimmunology, don’t just ask: Which antibody is positive? Ask: Which IgG subclass is driving the disease? IgG1 diseases (AQP4, MOGAD, NMDAR): → Complement activation → Inflammation IgG4 diseases (LGI1, CASPR2, MuSK-MG, NF155): → Protein interaction disruption → Often less responsive to IVIg → Frequently excellent responders to rituximab Mechanism predicts treatment response. Understanding antibody biology is increasingly as important as identifying the antibody itself. #Neurology #Neuroimmunology #AutoimmuneEncephalitis #NMOSD #MOGAD #MyastheniaGravis

TCD with bubble has the highest sensitivity to detect a right to left shunt and TEE with bubble has the highest specificity to diagnose a PFO. Cardiac CT has low sensitivity for PFO. Great work by @nbavar neurology.org/doi/abs/10.121…

Here’s a flowchart I generated using AI out of the 2026 AHA acute stroke guidelines for endovascular therapy (EVT) in acute ischemic stroke. #neurology #stroke #neuroX #FOAMed #MedEd #neurosurgery #EBM #medicine #vascular Two bits of nuance here ⬇️

A patient comes back with a second stroke. We immediately start looking for a culprit: carotid stenosis, atrial fibrillation, uncontrolled diabetes, resistant hypertension. But we never ask a different question: Did the stroke recur because the treatment failed, or because the treatment never truly reached the patient? The medicines were prescribed, but later stopped. The BP machine was never bought. Follow-up was missed because the hospital was far away. Rehabilitation was recommended but inaccessible. The caregiver was exhausted. The patient never understood that stroke prevention is a lifelong commitment. We spend a lot of time looking inside the artery. Perhaps we should spend a little more time looking outside the hospital gate. Because a perfect prescription does not prevent stroke. A prescription that a patient can actually follow does. Social Determinants of Health and Their Impacts on Stroke Prevention and Outcomes. #Neurotwitter #MedX, #Strokecare

We also had a quite similar observation. Spinal Cord PRES. In a 12yr girl. High BP. Albeit with supratentorial lesions too. Let us rename it as Potentially Reversible Encephalopathy Syndrome. x.com/nirmalregency/…

R3 Journal @R3_Journal

3 weeks ago

In a 14-year-old girl with headache, blurry vision, and hypertensive crisis, MRI revealed posterior reversible encephalopathy syndrome isolated to the brainstem and spinal cord subsequently found to be due to an abdominal paraganglioma. r3journal.org/doi/10.2214/R3…

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🧠🦎 A new article published in Practical Neurology’s new journal club format! GLP-1 receptor agonists—originally inspired by Gila monster venom 🦎—could become disease-modifying therapies for IIH. 🔗 doi.org/10.1136/pn-202… #Neurology #IIH #GLP1 #MedTwitter

👩‍🔬24-year-old woman with 4 months of progressive behavioral change, paranoid delusions, insomnia, memory impairment, and catatonic features. Fever later developed, prompting brain MRI. 🏥What’s your differential diagnosis?

The Tweetorial teaching points! #RGphx

Radiologists in the ED increasingly face imaging findings linked to recreational substances, that leaves a broad neuroimaging footprint in the emergency department. Know the patterns, save time, save lives. doi.org/10.1148/rg.250… #RGphx @RadioGraphics @teachplaygrub