43 year old woman with dizziness, hiccups, nausea. MRI shows THIS lesion in the medulla! anti AQP4 neuromyelitis optica? No! Hint: her father has progressive gait decline and motor/sensory neuropathy. Diagnosis?

After a very long hiatus, we are back at uploading lectures to our YouTube channel. Check this one out by Dr. Frauscher @AnphyLab #NeuroX #SEEG #EpilepsySurgery Trends and Innovations in SEEG (Birgit Frauscher, MD, PhD) #Epilepsy #Ep... youtu.be/GhrE-cuZ8-g?is=lGBx… via @YouTube

Many patients with vestibular injuries (Unilateral/Bilateral) develop a hardware glitch that leads to their ongoing dizziness - this infographic reviews how this leads to a software glitch and the need for VRT.

The biggest takeaway from the ICTRIMS Friday & Saturday sessions: The most important treatment in neuroimmunology is not a drug. It is getting the diagnosis right at the first attack. A few pearls I am taking back to my clinic: • Bilateral optic neuritis is MOGAD/NMOSD until proven otherwise. • Every LETM deserves AQP4 and MOG antibody testing. • Disc edema in optic neuritis is a diagnostic clue, not merely an examination finding. • Severe NMOSD attacks should trigger early consideration of plasma exchange. • A positive MOG antibody without the appropriate clinical syndrome is not MOGAD. • CIDP with tremor, sensory ataxia, root hypertrophy and poor IVIg response should raise suspicion for paranodal disorders. • Steroid responsiveness is not a diagnosis. What struck me most was this: We are moving from diagnosing MRI lesions to diagnosing disease biology. The clinician who recognises the phenotype before the antibody report arrives will often make the greatest difference to the patient’s future. That difference may mean preserved vision instead of blindness. Independent walking instead of wheelchair dependence. Recovery instead of lifelong disability. Excellent learning and thought-provoking discussions over the last two days at ICTRIMS. #ICTRIMS2026 #Neuroimmunology #MultipleSclerosis #MS #NMOSD #MOGAD #AutoimmuneNeurology #Demyelination #Neurology #NeuroTwitter #MedTwitter #MedicalEducation

A valuable learning from #ICTRIMS2026: In neuroimmunology, don’t just ask: Which antibody is positive? Ask: Which IgG subclass is driving the disease? IgG1 diseases (AQP4, MOGAD, NMDAR): → Complement activation → Inflammation IgG4 diseases (LGI1, CASPR2, MuSK-MG, NF155): → Protein interaction disruption → Often less responsive to IVIg → Frequently excellent responders to rituximab Mechanism predicts treatment response. Understanding antibody biology is increasingly as important as identifying the antibody itself. #Neurology #Neuroimmunology #AutoimmuneEncephalitis #NMOSD #MOGAD #MyastheniaGravis

TCD with bubble has the highest sensitivity to detect a right to left shunt and TEE with bubble has the highest specificity to diagnose a PFO. Cardiac CT has low sensitivity for PFO. Great work by @nbavar neurology.org/doi/abs/10.121…

Here’s a flowchart I generated using AI out of the 2026 AHA acute stroke guidelines for endovascular therapy (EVT) in acute ischemic stroke. #neurology #stroke #neuroX #FOAMed #MedEd #neurosurgery #EBM #medicine #vascular Two bits of nuance here ⬇️

A patient comes back with a second stroke. We immediately start looking for a culprit: carotid stenosis, atrial fibrillation, uncontrolled diabetes, resistant hypertension. But we never ask a different question: Did the stroke recur because the treatment failed, or because the treatment never truly reached the patient? The medicines were prescribed, but later stopped. The BP machine was never bought. Follow-up was missed because the hospital was far away. Rehabilitation was recommended but inaccessible. The caregiver was exhausted. The patient never understood that stroke prevention is a lifelong commitment. We spend a lot of time looking inside the artery. Perhaps we should spend a little more time looking outside the hospital gate. Because a perfect prescription does not prevent stroke. A prescription that a patient can actually follow does. Social Determinants of Health and Their Impacts on Stroke Prevention and Outcomes. #Neurotwitter #MedX, #Strokecare

We also had a quite similar observation. Spinal Cord PRES. In a 12yr girl. High BP. Albeit with supratentorial lesions too. Let us rename it as Potentially Reversible Encephalopathy Syndrome. x.com/nirmalregency/status/1…

🧠🦎 A new article published in Practical Neurology’s new journal club format! GLP-1 receptor agonists—originally inspired by Gila monster venom 🦎—could become disease-modifying therapies for IIH. 🔗 doi.org/10.1136/pn-2025-0050… #Neurology #IIH #GLP1 #MedTwitter

👩‍🔬24-year-old woman with 4 months of progressive behavioral change, paranoid delusions, insomnia, memory impairment, and catatonic features. Fever later developed, prompting brain MRI. 🏥What’s your differential diagnosis?

The Tweetorial teaching points! #RGphx

Radiologists in the ED increasingly face imaging findings linked to recreational substances, that leaves a broad neuroimaging footprint in the emergency department. Know the patterns, save time, save lives. doi.org/10.1148/rg.250046 #RGphx @RadioGraphics @teachplaygrub

Continuous EEG within 7 days after stoke identifies additional epileptiform abnormalities with prognostic value for post-stroke epilepsy beyond routine (short-duration) EEG. doi.org/10.1002/ana.78251 #EEG #epilepsy

The efficacy and safety of ketogenic diet therapy among adolescents and adults with drug resistant epilepsy: A systematic review and meta-analysis dlvr.it/TSnSrd #Neurology #Epilepsy

Maybe the best description of the general neurologist 1. Knows the 3 C's of neurology: • The Common • The Critical • The Curious 2. Comfortable in the ward and ICU 3. Skilled in diagnosis (localization, imaging, EDX, LP) and treatment (thrombolysis, ASMs, immunotherapy etc)

The interictal psychoses of epilepsy: A systematic review of case reports dlvr.it/TSpBXP #Neurology #Epilepsy

❶ | ❽ 🧵 #Stroke Last Known Well at ~2AM talking to her spouse. At 6AM found to have left hemiparesis. #MRI was performed at 800AM − 6 hours from LKW.

🧠 The 2024 #McDonaldCriteria are changing #MS diagnosis: 1. Optic nerve = 5th site 2. KFLC joins CSF biomarkers 3. MRI markers (CVS/PRL) ↑ specificity = Earlier & more confident dx of #MultipleSclerosis 🔗 doi.org/10.1136/pn-2025-0049…