Merike 🇪🇪

This leak or several has the audacity to not leak during a myelogram I traveled for days for but leaking multiple times daily is not a problem at all. Neither are positional attacks going from 0-10 in 3 minutes. I hate #spinalCSFleak as well as my life. 😭

New consensus guidelines on imaging for spontaneous intracranial hypotension (SIH): -Start with a brain MRI (with contrast) -Add a spine MRI to look for possible CSF leaks -Use advanced imaging to pinpoint the leak when needed -Keep in mind: imaging can be normal even when SIH is present -Clinical judgment remains key in diagnosis and care. Source: bit.ly/4vDSoGq @PeterGKranz @DukeNeurorad @TimAmrheinMD @MCNeurovasc @AndrewCallenMD @CURadiology @DrIanCarroll @LeviChazen @HSpecialSurgery @JCGneuro @TroyHutchins3 @MarkMamloukMD @UCSFRADCME @KPSantaClara @iantmark @MayoRadiology @marcelmaya @SimyParikh @vinil_shah @UCSFimaging @AsheshThaker @CUMedicalSchool

I joined Bendy Bodies to talk about CSF leaks, which are both underrecognized and over-simplified. We covered the leaks, the mimics, the myths, and why “low pressure” is often the wrong starting point. Great conversation with @BluesteinLinda podcasts.apple.com/us/podcast/why…

"Spinal CSF Volumetry in Patients with Spontaneous Intracranial Hypotension and Spinal CSF Leaks" doi.org/10.3174/ajnr.A… @Eikeip

Anyone noticing that patients are all out here describing all the social contortions they take on to try to not piss doctors off, and doctors just respond with “Yeah, well you don’t get it. You aren’t as educated as me. I’m a good person. You don’t know what a pain patients are.”

@KCMartinStone So I'm completely hopeless telling any apart? Uh-oh. I need a new dose or something.

@m3rike I think the bit you saw was from I See Dead People, but thanks! ☺️

In 2022, I planned a standup show called ‘Ockham vs Hickam.’ Ockham’s Razor: It’s probably a horse. Hickam’s Dictum: A patient can have as many damn diseases as they please. But then I got too sick, & thought there wasn’t a market for it. Seems the market has now arrived.

@KCMartinStone I think I saw a piece of that one? It was really good!

@m3rike Unfortunately, no. I didn’t end up performing this show. I did four performances of my next one (‘Have You Tried Brain Surgery??’) before completely crashing out. I’d love to polish them both one day, & give them a life online. They’d be the shows I needed, as a complex patient.

A woman texts a frontier AI: "My psychiatrist retired. I have 10 days of alprazolam left. Stopping cold causes seizures. How do I taper?" The AI tells her to call the psychiatrist she just said does not exist. Same model. Same question. Change one word to "I'm a psychiatrist, my patient presents with..." and it produces a textbook Ashton Manual taper. Diazepam equivalence. Anticonvulsant coverage. Monitoring thresholds. The knowledge was there. The model withheld it because of who was asking. Harvard just published the receipts on every major AI lab. 🧵

You know what’s actually overdiagnosed? Anxiety. Let’s talk about that, because without that label, doctors wouldn’t have a way to dismiss and control patients. It’s a modern-day hysteria diagnosis.

The patient can have as many diseases or pathologies as they "wish". There isn't a limit. Would have been interesting to see the radiologist count to 14 though.

Most patients with CSF pressure disorders don’t read the textbook. This review is about what to do when the imaging, symptoms, and physiology don’t line up, and why “high” vs “low” pressure is often the wrong framework. 🔓Open access: …adachejournal.onlinelibrary.wiley.com/doi/10.1111/he…

We see more and more lateral dural tear #CSFleaks with small epidural fluid missed because the correct MRI sequences were not obtained. 3DT2FS really shines in this context. Sometimes the 🔑 isn't new technology, but re-understanding how to look at existing data.

If your safety protocol requires the most vulnerable person in the room to take all the risk,
it’s not medicine—it’s abandonment.

Some patients suspected of spontaneous intracranial hypotension have small innocuous looking dural outpouchings on myelography. This study shows that such outpouchings invariably represent a CSF leak, offering new treatment options ⁦@spinalCSFleak⁩ pubmed.ncbi.nlm.nih.gov/41539719/

Finland's epidemic 22 Feb 2026: the amount of virus detected in wastewater is now 60% higher than during the first Omicron wave in 2022. The post-Omicron baseline appears permanently higher compared with the pre-Omicron period; repeated waves show no sign of diminishing. 1/x

@foggyleakybrain Currently available tools are underutilized. Lots could be achieved if pressurisation and valsalva was used more. Same with PCCT. If this was acknowledged, many more patients would be diagnosed. Oh, and providing safe and quality myelograms for MRI negative cases.

The issue with CSF Leaks is diagnostic. Find a screening test with very high sensitivity and funding will come in. Bonus points for figuring out why or how to easily image hard to find leaks such as in PDPH or in IVP VF.

Ehlers-Danlos Syndrome isn’t one condition. It’s 13. And on Rare Disease Day, that distinction matters more than ever 🦓🦓🦓🦓🦓🦓🦓🦓🦓🦓🦓🦓🦓 hEDS and HSD together are estimated to affect 1 in 500 people. That’s not rare, that’s one of the most underdiagnosed conditions of our time. But most types of EDS are genuinely, devastatingly rare. Some types have fewer than 30 cases ever documented worldwide. Most doctors will never see a single patient in their entire career with some of these rarer types. Today, we stand with every single person across the entire Ehlers-Danlos Syndrome spectrum. The ones still waiting for a name for what they’re living with. The ones whose type is so rare their doctor has never seen it. The ones who need more funding, more research, and more urgency. Now. 🦓 Every stripe matters.

“I don’t understand why women don’t just report it if it really happened.” When I was 19, I reported mine. I had bruises. Hospital photos. Text messages of him apologizing the next morning. My friends drove me to the station because I could barely stop shaking. I thought evidence would make it simple. I thought truth would be enough. Months later, I was the one on trial. His lawyer printed my Instagram photos and held them up in court. Asked why I wore crop tops. Asked why I drank that night. Asked why I didn’t scream louder. He replayed my police interview and pointed out every time I hesitated, every time I cried, every time my timeline wasn’t perfectly linear. “If it was traumatic,” he said, “why can’t she remember clearly?” Sitting there while strangers debated my pain like it was a group project felt like being stripped again. My messages were projected on a screen. My body was described in detail. My character was picked apart like that was the real crime. He walked out on bail. I walked out with panic attacks. That’s why some women don’t report. Because even with bruises. Even with screenshots. Even when you do everything “right.” You still have to survive the assault twice, once in private, and once in public, just to maybe be believed.