Charmy Lukban

#MondayTip ☝️Vertebrobasilar perforating arteries 🧠 ⭕️These small but vital arteries are essential for supplying the #brainstem and critical areas of the #posterior circulation From @eytanraz et al via @JNIS_BMJ 🆓 jnis.bmj.com/content/early/…

Just wrapped up my stroke fellowship elective at Royal Melbourne Hospital. Ended the week on a high note with the incredible mobile stroke unit crew. Grateful for the experience and the amazing teamwork! 🚑✨

#MondayTip Early neurological #deterioration in acute #lacunar stroke 📊15-20% of lacunar stroke 🕜Most common in the first 24-48hr 😥Associated with poor functional outcome ☝️Factors associated with END From: doi.org/10.1177/174749…

#MondayTip The #BrushSign in #CVT Hypointensity of the subependymal & deep medullary veins in 🧠MRI 👉In CVT is associated with higher thrombus load ☝️This sign may be a marker of CVT severity and should prompt close monitoring during the acute phase doi.org/10.1161/stroke…

#MondayTip Advances in Cerebral Venous Thrombosis #CVT From recent review by @Diana_A_Sousa and @LiaLucasNeto in @StrokeAHA_ASA #OpenAcces ahajournals.org/doi/full/10.11…

#MondayTip 🩸ICH Dawn of a New Era 🌎"ICH is a devastating disease, causing high rates of death, disability, and suffering across the world" 🎉2023 was a good year in ICH field: INTERACT3 ENRICH ANNEXa-1 💪and 2024 is not disappointing: INTERACT4 SWITCH 🔗journals.sagepub.com/doi/10.1177/17…

We’re proud to announce that Dr. Kate Khu of @pghneurosurgery is one of the invited speakers for the #GlobalNeurosurgery session @UofTNeuroSurge. From Manila🇵🇭 to Toronto🇨🇦, congratulations on your centennial and here’s to the next 💯!

#MondayTip High #Risk features in Nonstenotic #Carotid Plaque 🌒Beyond degree of #stenosis! ☝️You can use MRI, CTA, ultrasound, PET to evaluate Intraplaque #hemorrhage, Thickness, Volume, Neovascularisation, Lipid core, #Ulceration, Thrombus, Calcifications, #Inflammation and +

Spent the day with @DanniDiestro diving deep into the approach to LVO and witnessing his heartfelt homecoming in the Department of Neurosciences. Truly inspiring! 🧠

#Mondaytip Pathophysiology of #pregnancy-related #stroke : 🌊Hemodynamic changes 🔗Vascular & connective tissue changes 🩸Changes in coagulation system From: doi.org/10.1016/j.ncl.…

The next @JNIS_BMJ Journal Club is Thursday 4/4 at 4pm ET! Authors @DanniDiestro and Kyle Fargen, MD, MPH will sit down with JNIS Social Media Assistant Editor @DrAltschul with discussants @MattAmansMD and @Fie0815. Register: pulse.ly/vt4jehgy0c

#MondayTip #Acute neurologic #worsening after AIS 🩸Spontaneous or rTPA/TNK-related bleed? 🛌BP dependent exam? flatten HoB, bolus IV, +/- pressors 🛑Reperfusion injury or reocclusion after EVT? 🪜Stuttering lacunar? ⚡️Non convulsive/post ictal state? @caseyalbin Survival Guide

My attending once said, “If you don’t want to miss something, you have to know where look for it!” Intracranial aneurysms may occur at many locations, but overwhelming at the ACOM & PCOMM. Look hard at these regions! Remember, you miss 100% of aneurysms you don't look for!

#MondayTip 🧐The role of #MRI in diagnostic workup of #ESUS ☝️6.1% to 82.3% of patients w/ESUS were #reclassified using of MRI techniques like #cardiac MRI, MRA and/or #vesselwall MRI (vs standard workup) depending on the combination of imaging modalities journals.sagepub.com/doi/10.1177/17…

The new cSDH paradigm shift continues with further RCTs! The French EMPROTECT trial will evaluate the isolated benefit of MMA embolization as an adjunct to burr-hole cSDH evacuation bit.ly/3HMuAsc #SDH #MMA #Embolization

📣 Join us for our next INSPIRE Webinar 🗓️ Wednesday - February 28 - 12 PM EST 🧠 "Current Guidelines and Future Directions in Paediatric EVT" ⭐️ @SickKidsGHCBMH 🔗 Register: web.cvent.com/event/b71c51b8…

#MondayTip Small Vessel Disease & the #Glymphatic System #cSVD and glymphatic dysfunction are anatomically connected and significant RF's are shared between the two: 🗜️Hypertension 🍬Diabetes 👴Advance age 🛌Poor sleep 🩺Obesity 🧠Neuroinflammation 🆓 🔗strokejournal.org/article/S1052-…

@brainattackmd @pghneuro @epi_coll Thank so much tito Rob!

As a stroke fellow, it's always a great time giving back and sharing practical points in stroke management with @pghneuro. My pleasure opening this stroke lecture series. 🧠 Thank you, @charmysy and @epi_coll for the invite!

🧠⭕️ Ischemic Stroke ~ Major Causes Huge thanks 🙏🏾🙏🏾 to @MicieliA_MD @caseyalbin @ShadiYaghi2 for great suggestions & feedback!! #NeuroTwitter #NeuroRad #Neurology #Neurosurgery #stroke #MedStudentTwitter #FOAMncc #MedTwitter #FOAMncc #neuroscience #brain #CardioTwitter

Looking for a window into stroke treatment? Here's the window of opportunity to learn the stroke windows! It’s the cheat sheet you NEED to remember treatment windows in the newest @theAJNR SCANtastic: ajnr.org/content/early/… Read on for all you need to know in 1 easy stroke! You can remember the stroke windows by thinking of them as the time of day: ➡️< 4.5 hours 🔸Any patient can receive tPA if no hemorrhage 🔸4.5 hours= 4:30pm ♦️ 4:30pm is when you meet for coffee—you’ll meet anyone as long as they aren’t a bloody mess 🔹At 4.5 hrs, anyone is welcome to tPA as long as they don’t have hemorrhage ➡️< 6 hours 🔸Patients with large vessel occlusion (LVO) should receive thrombectomy 🔸6 hours = 6pm ♦️ 6 pm is happy hour. You only go out to happy hour w/people you are close to (proximal occlusion) 🔹Within 6 hrs, thrombectomy can be performed in close (proximal/large vessel) occlusion ➡️>6 hours (up to 24hrs) 🔸Patients w/LVO & favor perfusion should receive thrombectomy 🔸> 6 hours = after 6 pm ♦️Now it’s evening & you are only going home w/someone if they aren’t already COMMITTED to someone else 🔹After 6 hrs, thrombectomy for favorable patients w/perfusion showing the tissue isn’t already too COMMITTED to infarct 🌟Unfortunately, as research continues, many of these window guidelines may be going out the window! ➡️We have evidence that thrombectomy is also effective: 🔸In more distal occlusion & PCA occlusions 🔸In large core infarcts 🔸Using only non-contrast CT with CTA 🌟You can read more about the latest research in thrombectomy @theAJNR: ajnr.org/content/early/… Remember, when thrombus closes a door, thrombectomy opens up a treatment window!