Joyce

@MashiRafael Ya sólo te falta llorar, regresa a Ecuador para que tengas el mismo destino que Maduro

El pronunciamiento de la «Nobel de la Paz» ante el bombardeo de su propia patria🤦🏽 Tiempos muy feos para toda la humanidad.

@danielll2249 Para qué?

El beneficio de tener la altura.

Tired of always speculating about MR spectroscopy?   If you've ever looked at an MR spectroscopy & thought: "I have no idea what I’m looking at!"--then this cheat sheet is for you!   Here are the 5 basic rules you need so you can understand the spectrum of basic spectroscopy! (1) First you need to know the peaks.  —3 main peaks: Choline, Creatine, NAA —Remember the order bc a spectrum looks like mountain peaks & it is cold in the mountains.  And CHOld CREATures NAp or hibernate in the mountains (2) Hunter’s angle: —Most people know that the peaks of the spectrum should go up at you move lateral, called Hunter’s angle —Most bad things reverse Hunter’s angle —Ask yourself: Is my arrow pointed up to shoot into the air at the enemy (good) or is point to the ground where it will hit the dirt (bad)   (3) TE & spectrum length are inversely related —Spectroscopy follows the rule: speak softly & carry a big stick.  —Short TE = long spectrum, lots of extra peaks for glutamate/glycine, myoinsitol —Long TE = short spectrum, mainly the basic 3 peaks   (4) Each region has its own unique signature —Each brain region has its own unique composition of compounds that might alter Hunter’s angle a bit, but not reverse it —Need a control in contralateral normal brain so compare apples to apples   (5)Lactate peak goes like a sine wave —Lactate peak represents anerobic metabolism—sign of cells in trouble —It’s at 1.3ppm. Remember this bc 13 is an unlucky number & lactate is an unlucky sign! —It’s like a sine wave: up at short TE (35), down at intermediate TE (144), and up again at long TE (244) —You can use this flipping to better visualize the lactate peak —You can remember it’s down in the middle TE bc when you’re caught in the middle, you’re down & out   Just remember these tricks & you will be spectacular at basic spectroscopy!

We're lucky to have so many residents and fellows joining us at #NOH25! Your participation makes a difference! #AANadvocacy

What is the most likely diagnosis in this 30 y/o M presenting w/ a few weeks of headaches, photophobia, vision loss, confusion, and ataxia? More images in 🧵 #Neurology #Neurosurgery #radres #futureradres #MedEd #medicine @AlbanyMedRadRes

You started someone with a new diagnosis of epilepsy on treatment. For a couple months everything was going well. Then they had a breakthrough seizure. So you increased their antiseizure meds. The pattern repeats. Seizure. ⬆️💊 Seizure. ⬆️ 💊 Now what? Unfortunately this is an all too common situation. Nearly 50% of people with epilepsy won't get their seizures controlled from the 1st med they try. There are two schools of thought on what to do next. Add-on or Substitution therapy. The names are pretty self-explanatory, and the data suggest they are relatively equivalent in terms of potential efficacy. With add-on therapy you are adding on a 2nd 💊. With substitution you are trading the 1st 💊 for a new one. So how do you decide which path to recommend? A couple of questions to consider? 1. Did the 1st 💊 make any difference in seizure control? 2. Is the 💊 being tolerated well? If the answer to #1 is YES, it may be worthwhile to keep it on board. If the answer to #2 is NO, you probably need to consider strategies to reduce side effects (eg frequency of dosing, XR forms, etc) or changing to a new med. Another question to ask yourself is, "If I need to add a 2nd 💊, how will it interact with the 1st?" Check back later this week when we'll talk about the concept of rational polypharmacy (as opposed to irrational polypharmacy) in seizure med management! Don't forget to check in with @rohitmarawar and myself later this week for more about seizures and epilepsy! x.com/i/spaces/1rmgp…

I’m excited to share our new publication🧠: Number of Neurologists and #Neurology Training Programs available in the Public Health System of #Ecuador: Analysis & Recommendations. Available on: @RevEcuatNeurol revecuatneurol.com #neurotwitter @larkinneurons @larkinhospital

Because you read Continuum and follow #ContinuumCases, your reputation as a neurologic detective has grown. You get paged with a curbside: MICU: “Hi, neurology, we have a diabetic patient with uncontrolled movements, we’re worried he’s in status and…” You: “I’m on my way.”

Guys - check out the 2023 NeuroPocket from Simon Jung & team @inselgruppe @unibern All you need for the Neuro ED, available as .pdf neurologie.insel.ch/fileadmin/Neur… also at neuroed.app #FOAMed #EndNeuroPhobia #Neuro #NeuroTwitter SIMON JUNG @DavidSeiffge @FishingNeurons

🧠Full abstract available here: n.neurology.org/content/100/17… And stay put for our full-text manuscript! @joyceajz @JoseOrtegaTola1 @LuisYepezMD1 @WilsonCueva_593

🧠💫 #AANAM 2023 Poster presentation: Acute Paraparesis Syndrome after a Ruptured Aneurysm of the Azygos Anterior Cerebral Artery. Big ups to the coauthors: @joyceajz @JoseOrtegaTola1 @luiseduardoyepe @WilsonCueva_593 Honored to represent @larkinneurons & @larkinhospital

Ecuador 🇪🇨 presente #AANAM @joyceajz @danielmorenoz @MFVillamarMD @AnaCAlbujaMD

Dos enormes ejemplos que la vida me ha puesto en el camino Las amo. @joyceajz @neurologiagye Mi primer póster en @AANmember

🧠Neurology Tweetorial🧠I'm often asked about localization/diagnosis in the challenging clinical presentation MULTIPLE CRANIAL NEUROPATHIES. Here is my approach, what is yours #MedTwitter #neurotwitter @NMatch2023 @rabihmgeha @DxRxEdu @caseyalbin @AvrahamCooperMD @a_charidimou?

#ContinuumCase, plot twist edition: A 28 year old PGY2 neurology resident is asked by her attending to review 2 scans and determine the diagnosis: Alzheimer disease (AD) or dementia with Lewy bodies (DLB). What should she say, #neurotwitter?🧵

In 1993, the WHO dropped the word multiforme from its classification, so a grade IV astrocytoma is correctly called glioblastoma. Thus this marks the 30th consecutive year that we have been incorrectly calling it a GBM instead of a GB.

Throwback #ContinuumCase: An 18 year old with episodic dizziness underwent EEG (event captured) and was diagnosed with right frontal focal onset seizures. No improvement with oxcarbazepine. He asks you to review. EEG tracings below. What’s going on, #neurotwitter?🧵

@danielandivar92 Te amo muchísimo ♥️ trato de disfrutar cada segundo que estoy contigo 🥹

La vida es de momentos. Y yo ahorita viviendo de los mejores contigo. @joyceajz ♥️ sacándole el jugo a cada minuto a tu lado y a lado de Hope.

Q: What is the most common cause of infectious rhombencephalitis?