Ramesh Durairaj

Today, new Stroke Guidelines were published. They include an update to the classic CHANCE/POINT protocol, but the flowchart may be confusing at first glance. I built an interactive version to simplify!

2/ View the paper and supplemental resources here: spr.ly/6016CCzHa

@elonmusk Yup. The whole world should change to make sure you earn your dough!

The EU should be abolished and sovereignty returned to individual countries, so that governments can better represent their people

Australia just recorded zero cervical cancer cases in women under 25 - for the first time since records began in 1982. This is what happens when a country commits to HPV vaccination and screening. We protect our girls and save lives.

Dublin has opened its first dementia-inclusive shopping centre! Congratulations to our friends at @alzheimersocirl on this milestone in Ireland’s journey toward dementia-inclusive communities alzheimer-europe.org/news/dublins-f…

Neuro-ophthalmology has two divisions Afferent - vision Efferent - eye movements Efferent neuro-ophthalmology has 6 supranuclear control systems There are 6 systems of supranuclear control 1. Saccade 2. Pursuit 3. Vergence 4. Fixation - microsaccade, microtremor and microdrifts 5. Vestibulo-ocular reflex (talking only about angular VOR here) 6. Optokinetic nystagmus (OKN) [slow OKN = slow phase and fast OKN = fast phase] Why do we need 6? For that we have to go back to evolution. The earliest animals had only vision WITHOUT a fovea which is the point with the highest visual acuity in the retina --> this was around 520-500 million years ago So they needed to keep only the visual field in line with the head since there was no fovea! So they developed the angular VOR and the OKN which had two different functions VOR --> head movement WITHOUT movement of visual field OKN --> only visual field moves WITHOUT head movement But these usually operated together since most situations had simultaneous movement of the head and visual field Around 450-400 millions ago, the fovea began to emerge --> this allowed fixation and much better visual acuity Fixation --> keeping the object of interest on the fovea for maximum vision Fixation involves miniscule movements called micro saccades, microtremors and microdrifts which help keep the object on the fovea --> these miniscule movements allow phototransduction rather than maintain fixation (that is a different issue altogether) But how to maintain fixation on an object when the head of the animal is constantly moving? Pursuit --> this moves the eye along an x and y axis Vergence --> this maintains fixation along a z axis Now what to do if we want to break fixation and focus on a new target? We have saccades! Now what about the older supranuclear systems of VOR and OKN? They do well with fixation but they have evolved for at least 100 million years where they did not have fixation! So they can do WITH and WITHOUT fixation. In conclusion VOR and OKN --> maintains visual field with and without fixation Pursuit and vergence --> essential to maintain fixation Saccades --> essential to break up fixation and acquire new fixation This is a heavily simplified account of the evolutionary basis of eye movements! #MedTwitter #NeuroTwitter #Neuroophthalmology #EyeMovements

Question for the day What part of the brain has feet on its head? #Neurology #neuroradiology #MedTwitter

Time to go with the flow! Knowing vascular anatomy is the first step to reading any angiogram These are the key vessels you need to know! Then I always remember to check for pathology using the mnemonic ANGIO to remind me what to look for: A = aneurysms, arteriovenous malformations N = Narrowing (atherosclerotic narrowing) G = Globules (globular or beaded appearance in vasculitis or RCVS) I = Irregularity/dissction O = Occlusion (large vessel occlusion for endovascular) So now you know the anatomy & pathology to look for angiographic studies! Hopefully, now you will never have to circle back on a study of the circle of Willis!!

Wordle 1,232 2/6 🟨⬜⬜⬜🟨 🟩🟩🟩🟩🟩my lucky day

@Deborah71247971 @TheStrokeAssoc @NHSGIRFT @WUTHnhs Congratulations and all the best.

I am so excited to start this new role as Medical Director for @TheStrokeAssoc 💜Working a day a week with the UK’s largest stroke charity. I will continue as @NHSGIRFT National Clinical Lead for Stroke and as a stroke dr @WUTHnhs and will support improving stroke care for all 💜

@teachplaygrub Should it be dentate gyrus?

8/As we go posterior, we come to the body. The body is where you can see the spiraling line that is the Cornu Ammonis. The Cornu Ammonis spirals into the dentate nucleus, which is cupped around the end of the Cornus Ammonis so that they look like a yin-yang.

2/Its name “hippocampus” comes from its shape on gross anatomy. Early anatomists thought it looked like an upside down seahorse—w/its curved tail resembling the tail of a seahorse. Hippocampus literally means seahorse.

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There is no better expert at whinging than MV!

TEMPO2: TNK (0.25mg/kg) vs BMT for minor strokes 💉 Trial reported neutral results on return to baseline function with ⬆️ sICH and mortality in the TNK group ❌️ Older & female pts might benefit more from BMT #ESOC2024 #VoiceOfStroke

Major studies from ESOC2024 including our own TACTICS

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#BMJResearch Among hospital patients with at least one episode of delirium, the risk of receiving a new dementia diagnosis was 3 times higher than for patients without delirium and each additional episode of delirium increased that risk by 20% @DrEHGordon bmj.com/content/384/bm…

Hyperactive Delirium Patient Experience with Vocals youtu.be/GEXR9YLMGt4?si… via @YouTube

Antipsychotics used too often as a first-line response to difficult behaviour in #dementia (most often agitation) rather than as a considered second-line treatment when other non-pharmacological approaches have failed via @NHSEngland england.nhs.uk/london/wp-cont… #BGSconf

Looking for a white knight to help you remember white matter anatomy? Do questions about white matter make you turn white as a ghost? Well, here’s a white-hot way to remember it! Coronally, major white matter tracts look like 2 people dancing—can you see it? Let me explain! 🌟Here’s how to remember the major tracts🌟 ➡️Motor tracts/Posterior Limb of the Internal Capsule/Corticospinal tract: 🔸Corticospinal tract goes through your CORE & SPINE. 🔸It's the body of the dancers going all the way down to the medial feet they balance on ➡️Corpus Callosum: 🔸Letter C looks like hand reaching to grab—it is the two hands reaching in the middle ➡️Superior Longitudinal Fasciculus: 🔸What is superior & long in your body—your arms! 🔸Superior longitudinal fasciculus are the arms of the dancers reaching back ➡️Inferior fronto-occipital fasciculus & Inferior longitudinal fasciculus 🔸What’s inferior & long in your body—your legs! 🔸These are the back leg of the dancers. 🔸Inferior longitudinal fasciculus is the foot bc LONG means it’s the longest or farthest away from the body So now you can always find the major white matter tracts on a coronal image! Hopefully, now you can be right about what’s white!