I’m an undergrad interested in pediatric neurology, can you suggest me a source that’s suitable for an undergrad as a main studying source?

I'm a paramedic student doing an assignment and using this patient but part of her presentation is driving me insane because I can't figure out what happened.

Unknown aged female, known vagrant walked into the road and collapsed. A car driving past stopped and the lady pulled her out of the road and tried to get her to stand or move but the patient was unresponsive. On arrival, the patient was in fetal position and unresponsive. By look (she looked to be in rigor), she appeared dead, however later vital signs showed otherwise. The patient was unresponsive to any stimuli.

Her vitals on arrival Bp: 123/85 HR: 80 Spo2: 99% Respiratory rate: 32, shallow and snoring HGT: 6.1 Temp: 35.4°C Pupils pinpoint and equal

The only history we were able to get out of people surrounding her was that she was attacked and hit in the head with a brick 2 weeks prior and had a laceration and old blood above her left ear. And that she was a known methamphetamine user (tik).

When we loaded her, she was decorticate(?). Her arms were to her chest and every single muscle in her upper body was rock hard. We checked pupils again (suspecting drug overdose) and the right pupil was blown and sluggish to light with the left normal and reactive. One of my partners thought it was a drug overdose and gave her 0.1mg of IV naloxone which (kind of obviously) did nothing.

We tried to take her wet clothes off, she started moaning/ screaming and went from flexing toward her chest to extending and pulling away. Her eyes were completely closed during this ordeal and she stopped fighting the second we stopped taking her clothes off.

This is where my question is but I'll give the rest of the treatment after. Why did she go from completely unresponsive (we did sternal rub, ear pinch, shoulder pinch and inserted an IV) to suddenly fighting? From the get go, I suspected a TBI because of the abnormal flexion, but the injury was so old and there was no other visible trauma. We didn’t give benzos because it wasn't in my supervisors scope. Is it possible that even with a brain bleed, she still held onto some sort of fight or flight response? We did a plantar scrape test which resulted in nothing. What causes such a massive change in response? It's driving me insane.

The crew I worked with wasn't qualified to intubate so we took her to the nearest hospital where she was intubated under etomidate, which she ate through in under 10 minutes and propofol. The person that intubated initially went too deep and the patient desaturated (~70%) and started hyperventilating. When it was corrected, the patient was breathing entirely on her own through the bag valve tube and started to bite down before the propofol was given. At no point was she given a paralytic in case neurology wanted to do further testing. She was referred to a hospital that had a CT. It was suspected that it was a subdural or sub arachnoid hemorrhage with possible seizures. I unfortunately never got the full diagnoses as a different crew took her to the other hospital.

Neuro resident here. I was recently talking with a senior resident who told me she is starting a fellowship next year in Woman in Neurology. As I’m starting to think about sub specialization and fellowships, I wanted to ask what other fellowships do you know of that might be considered a bit more obscure?

I just got hired at a pediatric hospital as an EEG tech, and have the choice to work 6a-6p for day shift or 6p-6a night shift. What are the differences between the two shifts that I should know?

... to start learning as a neurology resident. Looking for a resource that is not dry, and has only points of practical value and is fun to follow.

Hello everyone, I applied for neurology this MATCH cycle, I would appreciate any advice on how to ace my interviews. Also I appreciate if someone here is in a neurology program and can help me get an interview in his program.

I'm confused about this one. Done with residency. I love Epileptology not just for the flexibility it gives regarding working from home and doing other things like preop work-up, also think Neurocrit is something I've been living in denial about. Abit worried if there's a good life balance there, litigation rates and if I might prefer something more outpatient as I get older. Not sure about differences in pay between the two. Would appreciate inputs from the more experienced persons.

Hey all - there are many threads here on salaries, but it's all over the place and does not have the full context of comp - e.g., including shifts, schedule, PTO, benefits, location, etc. to make it useful

A few months ago, my anesthesiologist friend tested a spreadsheet format in the Anesthesiology sub-reddit and has crowdsourced >500 anonymous salaries for the community. It has become an extremely helpful resource for them to ensure they are being paid fairly. I have worked with him to extend the sheet and the questionnaire to other specialties as well. Looks like there are 7 neurologist salaries added already.

We all know that medicine needs more transparency and this is information we all need to make sure we are fairly paid. All the salary reports out there are just not useful - they are either too broad and not specific to our situation or cost $$$. This is fully anonymous, so it really decreases the taboo of discussing our comp.

Here is the salary questionnaire - https://marit.fillout.com/t/vfyw8PEHj2us

Let me know if you have any feedback on questions in there. And you see the data collected so far here. Add your comp info if you are willing, and it will unlock the full spreadsheet. The more data we get in there, the more useful it will be for everyone!

This week's article is about Peripheral Neuropathic Pain by Victor Wang, MD, PhD and Miroslav Bačkonja, MD. There is a great podcast episode with an interview with one of the authors, Dr. Miroslav Bačkonja.

Last week's article was about Spine Pain by Dr. Vernon Williams.

Why are deep tendon reflexes preserved in myasthenia gravis? If antibodies are blocking the neuromuscular junction then how is the reflex elicited?

M4 here. Looking for resources to learn, study, visualize normal and pathologic angiography of the cerebral vasculature. Essentially, anything akin to ‘Neuro Interventional for Dummies’😅 Any recommendations are welcome! No luck thus far finding something online for introduction to the field.

Hi, I hope this is appropriate to ask, I'm just really curious and have no one to ask tonight. I've worked neuro ICU for years but I've only had 2 patients with idiopathic intracranial hypertension, one had an EVD and the other had a bolt.

My current patients is not on a neuro ICU, so no neuro providers to ask, plus it's nightshift. They are concerned this patient has IIH, CT only notable for empty sella and a lumbar puncture with a pressure of 29.

Is there a particular reason you would do an EVD vs not do one? Would an EVD only be indicated if the ventricles were also enlarged or wouldn't you want one to measure ICPs? Or is the risk of infection not worth the ICP readings?

Thanks for any insight! I'm really curious and have nobody else to ask :)

I'm looking for good sources to keep up to date on latest neurology research. What are considered the best/top neurology journals?

Hi everyone! In your opinion, what are the best child neuro residency programs in the US and why? I'm in the interview season and would love your input!

Hello, I am 6th year medical student from Europe. My question is there any kind of validated symptom inventory/questionnaire for tracking/self-reporting premonitory symptoms of migraine? I will need it for my thesis and I would appreciate if you could share some informative or relevant resources if such instrument exists. Alternatively, I will need to construct it from scratch or modify existing ones.

Thank you very much! :)

I have noticed a surprising amount of variation in what I see staff, co-residents, and the internet recommend testing for/interpreting normal vibration thresholds.

Classically in medical school, I was taught to strike my 128hz tuning fork and put it on the DIP joint in the hands and the IP joint at the great toe, with our finger on the other side of the joint. A patient was said to have normal vibration thresholds if the patient could no longer feel vibration near/at the same time we could no longer feel vibration. I think this is a reasonable approach and has served me mostly well thus far, however, there are issues with this including differences in what normal vibration thresholds are with age, the thickness of patient toes transmitting the vibration sense to your hand, if the examiner has large fiber peripheral neuropathy themselves in the fingers, etc.

I have also noticed that there is a variation in what certain subspecialists consider normal. For example, many MS neurologists that I have worked with tend to be more stringent in what they perceive as normal for vibration threshold in the toes(for the obvious reasons of typically working with younger patients and being more attuned in looking for DCML dysfunction). I have found that I tended to under-call vibration threshold abnormalities in this setting, and now that I have adjusted my barometer, I am finding myself overcalling vibration threshold abnormalities in inpatient/other settings.

I have seen books by Blumenfeld recommend checking vibration at the pads of the toes and NOT checking over bony prominences on joint spaces, where almost all other sources I've come across recommend the latter approach.

So my question to you all is:

How do you test for vibration threshold in the fingers and toes?

What do you consider is an abnormal vs normal test in the fingers and toes (particularly the toes, as I feel like in most situations using our own DIP threshold is reasonable)?

Thank you very much,

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This pertains mainly to academia, because I'm guessing that's pretty much the only place that it remotely matters. I put active in quotes, because I mean the least involved form of being active in that you keep paying the membership fee and/or consistently attend the yearly meetings, and not actually participate in any of the committees/consortium/board/etc. Does it help at all with promotions or anything? Besides, you get some extra letters at the end your name?

Hi I want to get better at reading imaging. I still kinda suck, any resources?

Hi All,

What website can I search for a stroke attending positions? Currently doing a fellowship but I think it is time to sign a contract. Also mgma salaries are showing around 420K but not sure how it is irl. Thanks for the help.

Hi, I’m an OMS2 interested in peds neuro after discovering the field through summer research. Looking for any advice on how to match. I saw our rotation electives for 3rd year don’t have a peds neuro elective but have adult neuro, will that hinder my ability to match if this is the specialty I want? We can do away rotations 4th year in peds neuro from what I heard.

Also is it important to take both COMLEX and USMLE to match? We need the school’s permission to take USMLE based on mock scores, class rank, and whether they think our specialty needs it.

For anyone who did a fellowship in vascular neurology, could you share your set up and salary? Trying to see how feasible it is to primarily work inpatient and if I have to do clinic how feasible it is to only see stroke patients. I also noticed most recent MGMA data has vascular neurologists higher paid than others, so I’m curious about salary. Thanks!

I recently came across “When air hits the brain” and liked it very much.

Do you have any neurology-related books you found interesting that you would like to share?

This week's discussion article is Spine Pain by Vernon Williams. I thought this was a very interesting article discussing spine pain as it is relevant to a neurologist. doi: 10.1212/CON.0000000000001473

If you haven't been following, please see last week's article about Principles of Pain Management.

Hi guys, this might be slightly too niche but I’m a current PGY3 and I have notes from our lectures, random learning points from attendings, question banks, etc. I feel like they’re all over the place and wanted to see if anyone had any suggestions? I recently got an iPad so not sure if there are good apps or better ways to keep everything organized in one place

With regards from Dejong

This is on the topic of pronator drift. Flexors (pronators) are non-CST innervated, extensors (supinators) are CST innervated thus if there is a mild CST lesion flexors overpower extensors and produce pronator drift.

But I can't find any explanation as to how non-CST innervated muscles receive innervation. Is it lateral/anterior CST difference?