Lawrence Robbins, M.D. Riverwoods, Ill Neurology

9. Ten Years After performing "I’m Going Home"

Dear Neurology Residents Starting in the ED Next Month, You will frequently encounter “?GBS” or “GBS rule out” consults. Please remember to carry your reflex hammer, save this post for future reference, and read the open-access review that I share ⬇️. 🤓 Since you won’t have much time for history taking, make sure to ask about important details such as falls, the use of gait aids, the ability to climb stairs, difficulty walking, using zippers, and washing their hair. These activities can help you gather an accurate timeline. I also suggest asking when they last felt like their usual selves, as this can help pinpoint when the symptoms began, along with their prior level of disability, which is crucial. Don't forget to ask about potential triggers, including recent vaccinations, infections, surgery, and trauma. The following physical examination features make GBS very unlikely and may assist you in “ruling it out”: - A sensory level - Unilateral weakness - Markedly asymmetric weakness (excluding cranial nerves) - Weakness confined to either the upper or lower limbs - Normal (or preserved) ankle reflexes - Fever or skin rash - Normal gait GBS is the most common cause of ascending weakness and paresthesias. So, if history suggests it, the patient is unable to walk, the weakness is symmetric, and the reflexes are reduced/absent, please admit the patient and start IVIg overnight. Time is nerve! 😅

Up to 80% of individuals with Autism Spectrum Disorder (ASD) show ADHD symptoms, and up to 50% of those with ADHD meet ASD criteria (Lau-Zhu et al., 2019). DSM-5 formally recognised co-diagnosis, reshaping how we assess, manage, and support neurodevelopmental overlap. Let’s examine the neurobiological overlap, diagnostic complexities, and treatment considerations driving clinical care. 🧵👇

I really don’t understand how dudes traveled the seas 500 years ago

Rickey Henderson is on first, and he’s looking to run. You can have any Catcher from any era try and gun him down. Who gets the nod?

A common misconception regarding the treatment of Guillain-Barré syndrome (GBS) is the idea that it can be categorized as either "IVIg responsive" or "resistant." The only two therapies that are effective for GBS—plasma exchange and intravenous immunoglobulin (IVIg)—do not change mortality rates or long-term disability outcomes. Yes, you read that correctly. Both treatments are quite expensive, and clinical trials have shown that, compared to placebo, they only lead to accelerated recovery, with no significant difference in disability at one year or mortality rates. Some of you may think I’m crazy for repeatedly stating that "Time is Nerve," but I strongly believe this to be true. The variation in response to immunotherapy in GBS is most likely related to the timing of starting treatment for an individual patient's disease course. This is why it is crucial to initiate therapy as soon as possible. I believe that starting treatment early may change the trajectory for many patients on an individual level. Research indicates that the neuropathic process in GBS begins several days before patients exhibit any symptoms. After antibodies have been deposited in the nerves and complement activation occurs, plasma exchange or IVIg cannot effectively treat the damage that has already taken place in the nerves. While these treatments may help prevent further injury caused by antibodies or complement/cytokines, they cannot reverse the damage that has already been activated. As a result, patients with severe GBS who present to the hospital within less than three days or who become unable to walk in that same timeframe are likely to require mechanical ventilation and face a poor prognosis. 1/x

Psych Scene Snapshots 🧠📷⚡ Q: How do you differentiate the mood dysregulation of BPD from Bipolar Disorder? A: Mood shifts in BPD are rapid (minutes to hours), often reactive to interpersonal stress, and closely tied to identity disturbance and fear of abandonment. In contrast, bipolar episodes are sustained (≥4–7 days), often arise without external triggers, and involve clear changes in energy, sleep, and cognition. BPD is characterised by heightened affective reactivity to interpersonal stressors, particularly intense anger, shame, and fear of abandonment. In contrast, bipolar disorder features sustained mood episodes (mania, hypomania, or depression) lasting days to weeks, interspersed with periods of relative euthymia and functional recovery. Psych Scene Tip💡: Ask about duration, trigger, and trajectory. If mood swings are moment-to-moment and relational, think BPD. If mood states dominate for days to weeks, think bipolar. *About 20% of bipolar II patients and 10% of bipolar I patients have comorbid BPD, and there is a robust relationship between BPD and bipolar disorder II (Zimmerman and Morgan, 2013)

📢 NEW Course | NEUROLOGY MADE EASY • 26 July 2025 🗓️ • ⁠7:30am - 4:10pm ⏱️ Target Audience : • 1- Internal Medicine Residents • 2- Family Medicine residents • 3- Junior Neurology residents • 4-Hospitalist / Family medicine practitioners • 5- Interns