Retinal migraine
Ocular migraine
-Does not exist
Retinal migraine
Definition: rare form of migraine that causes temporary vision loss in 1 eye
Standing on the shoulders of giants
Standing on the shoulders of giants
Ruth H. Walker
-Reference in genetic chorea
-Intrigued by a family with chorea and normal HTT replication, led to identification of JPH3 gene, later nominated HDL2 chorea
Sarosh R. Irani
-Referenfce in LGI1
-Reviewed uncountable number of video EEG of patients that end-up dying until noticing the specific FBDS pattern
Lumbar puncture
Lumbar Puncture
Anatomy
“Some Spanish Students Ingest Lime-Flavored Drinks And Sip”
S: Skin
S: Subcutaneous tissue (superficial&deep fascia)
S: Supraspinous ligament
I: Interspinous ligament
L: Ligamentum flavum
F: (Epi)Fural space → remember this is the epidural space
D: Dura mater
A: Arachnoid mater
S: Subarachnoid space
Landmarks
-“Pop” = ligamentum flavum
-CSF after dura + arachnoid
Before LP
- Do neuroimaging (CT/MRI) before LP
>Neuroimaging/LP should not delay therapy
Needle types
-Atraumatic (pencil-point): Whitacre, Autocan, Eldor, Greene→ Lower PDPH
-Cutting needle: Quincke→ Higher PDPH risk
-Epidural needles: Tuohy, Crawford→ Do NOT enter subarachnoid space intentionally
Contraindications
Absolute
-⬆️ICP 2/2 mass
-VZV at lumbar site
-Coagulopathy (Plat < 50K, INR > 1.5, PTT > 45s)
-Suspect epidural abscess
Relative
-IC mass without inc ICP
-Coagulopathy that can be reversed (give Plat)
Regarding anti-thrombotics/ thromboprophylaxis
-Non-urgent vs urgent LPs
Interesting
- Clopidogrel→ no correlation P2Y12 & LP safety, still time should be used
Meningitis
Meningitis
Epidemiology
Mortality
-Highest mortality→ Listeria
-Highest number (overall)→ Strep pneumoniae
LGS
LGS
Management ASM
1st VPA + CLB
2nd add LMT
3rd everything (Rufinamide, TPM)
4th Fenfluramine, Cannabidiol, felbamate
MRI Spectroscopy
MRI Spectroscopy
Basics
- 3 peaks (Cho, Cr, NAA) and lipi-lactate peak
Cho & Cr
- Always together
- Energy marker
- Around 3 (b/c Cr rhyms w/ 3)
NAA
- Neuronal health (N for 'N'euron)
- Double (2x) Cho (NAA has double b/c 2 As)
Rules
❶Hunters angle
- UP is good, DOWN is bad
❷Ratios
-NAA/Cr(abN <1.6)→ viability of the tissue
-Cho/Cr (abN >1.5)→ indicates cellular proliferation, used to grade neoplasms
-Cho/NAA(N=0.6) ⬆️SN&SP than NAA/Cr & Cho/Cr ratio to differentiate gliomas
❸TE (echo time)
- Short TE→ long spectrum, lots of extra peaks (but variable baseline)
- Long TE→ short spectrum (baseline more stable)
>Higher field (1.5 vs 3T)→ better baseline
❹Signature
- Each region has a unique signature
>GM: ⬆️ Cho and Cr, ⬇️NAA
>WHM: ⬆️NAA
- Select control appropriately
❺Lactate
- Lactate peak is a sine wave, TE-dependent
>Short TE→ peak 🔼
>Middle TE→ peak 🔽
>Long TE→ peak 🔼
❻Peak valuable table
- Except by Canavan, all other conditions are nonspecific
Considerations
History
- 1H (Proton)-MRS available since 1980
>Add 5-10 min extra; but, limited clinical value
>1.5T and above
XY axis
X axis=resonance frequency of metabolite (ppm)
Y Axis=Height of molecule peak depends upon concentration and available 1H
AUC=concentration of metabolite
-3RF pulses 90, 180, and 180 (≠ angle)
-Free induction decay ➡ Fourier transform ➡ Spectrogram
>Metabolites waves are compared to water
>Remember to suppress water; otherwise, huge peak and no metabolites
MRS types
-Single-voxel (PRESS) vs multi-voxel (MRSI/CSI)
>Better multi-voxel, but takes longer time
>MC in neuro is for tumor (board and interior)→ use multi-voxel
ASM Interactions
ASM Interactions
Only interesting and freq asked
Valproate
Clobazam
VPA ⊖→ CYP2C19→ ↑N‑desmethylclobazam
The increase in clobazam does not change VPA level
Neurofibromatosis
Neurofibromatosis
-Manchester
Management
NF1
NF2/ NF2-related schwannomatosis
AKA: MISME (multiple inherited schwannomas, meningiomas, and ependymomas)
Definition
AD characterized by multiple CNS tumors
History
1992 Manchester criteria
2017 Revised Manchester
2022 NF2-related schwannomatosis
Pathophys
-22q12.2→ Merlin (tumor supressor gene)
>cytoskeletal and contact-dependent
-Schawannomas→ Antoni A & B
A→ dense (Verocay bodies)
B→ loose
Incidence
1 in 40,000 births
Dx
-NF2-SWN 2022
DDx
-Schwannomatosis→ only peripheral, no central
-If found NF2:
>Annually eval→ bMRI, ophthal, audiologic
>Every 2y→ spine-MRI
-If tumor present, more freq
-Therapies
>Bevacizumab→ good VS, poor meningioma; SAEs in 10% (HTN, thromboembolic)
>Brigatinib→ good VS and meningioma
Neuronland History
Neuronland Blogspot History
Purpose
- Self‑repository of articles
- Concepts and lessons learned throughout my life
Authors
Jamir Pitton Rissardo
Ana Leticia Fornari Caprara
Remarkable milestones
🏅Jan 3, 2020
>1st post
https://neuronland.blogspot.com/2020/01/number-1-article-type-case-report.html
🏅Jan 30, 2026
> 1,000,000 views
🏅Apr 12, 2026 → free Google indexation
Subscribe to:
Posts (Atom)