Welcome. My name is Igor Rybinnik, and I am Vascular Neurologist and Neurology Clerkship Director at Rutgers Robert Wood Johnson Medical School. Hippocrates said, “From the brain only, arises our pleasures, joys, laughter and jests, as well as sorrows, pains, griefs and tears." Even in the 4th century BC, the father of medicine, recognized the paramount function of the brain and central nervous system in the human body. Centuries later, neurology emerged and developed into a large and diverse field firmly rooted in neuropathology, branching into theology and metaphysics, budding psychiatry and flowering neurological surgery. To me, neurology is the field that is best poised to define the most essential and elusive human concept -- the human soul -- and localize and treat its ailments. That is neurology’s irresistible allure. I am a Neurophile. Are you?
Is there any signs or symptoms that guides us towards a diagnosis of an intracranial dissection vs an extracranial one, or diagnosis is just radiologic?
Intracranial dissections typically present with thunderclap headache and subarachnoid hemorrhage or ischemic stroke. The clinical signs guide you to the vessel involved, and then diagnosis is established with vascular imaging. That being said, intracranial dissection is challenging to differentiate from RCVS, and both present similarly. Sometimes presence of trigger (like SSRI) and the vessel segment that is involved helps. But ultimately, these patients get a conventional angiogram.
I'm medical students i don't know how to express my feelings after i went through your video, i was disappointed i couldn't understand any thing in university, thank you so much for this incredible lecture ❤️
Diagnosed in 2021 with vasoconstriction after aborted stroke. Just had second incident stroke/brain bleed. Terrified as told nothing we can do to prevent other than channel blocker and eliminate stress.
First year neurology resident here. I cannot thank you enough! Can't wait to go through all of your videos. Coming across your channel was such a beautiful serendipity!
I am contacting you ,because I watched your video Brain Imaging crash course and was surprised by the extensive knowledge and really wanted to ask you to look at the MRI images of the head with contrast, since you are reading them.
@@M_9m_9m_9 Hi. I should say that I am not a radiologist, but a Stroke neurologist. The video I created is intended for trainees to learn an approach to imaging interpretation. If you are a medical trainee, I am happy to discuss scans for educational purposes over the internet. However, proper interpretation of imaging for diagnosis and treatment requires clinical history and neurological examination. It's impossible to offer a useful opinion on scans without being able to evaluate a person in clinic. MRI is only a small part of the diagnosis. If you need an opinion on scans for the purpose of diagnosis/treatment, I highly recommend that you see a neurologist for a proper evaluation.
Yes, it's hard with the doctors.I'm not speaking for everyone, but for the majority.I went to the neurologist, they didn't really find anything, so I decided to watch the video and study medicine, of course they did an MRI at the request of the neurologist.It's just that after watching the video, I was surprised that you read the pictures first-class.That's why I wrote, I thought you could at least look like this.And thank you so much for responding!
Wonderful video. It is so informative. Thank you for doing this. One minor correction. Chorea is not a Latin word, it is Greek. As you mentioned it means "to dance" or simply "dance".
The video is a little dated at this point. ELAN trial helped make this subject a little more straightforward, but I’m waiting for the rest of the anticoagulation trials to be published before remaking the video.
thank you so much for this great content. May I ask that I use some of the slides/ illustrations that you have used in the presentation? and If yes how would you like me to cite it?
Have you done any videos on subarachnoid cysts? My husband was a flight medic in the army and spent 34 months in combat where he received multiple concussions (not diagnosed until a couple years after his final deployment). After noticing lots of cognitive changes, we finally convinced the military to do an MRI and they found a softball size subarachnoid cyst on his right frontal lobe. They basically kicked him out of the military because of it but no medical providers have done anything other than treat his headaches and monitor. Some say it had to be congenital, but he remembers having an MRI in high school after a concussion and nothing was ever said about a cyst. Since it was discovered in 2018, we have definitely seen a decline in his executive function and cognitive functioning as well. I’m just wondering what kind of information there might be out there when it comes to something like this..
@@tawnycampbell8451 Unfortunately we haven't done any videos on subarachnoid cysts. Often they are benign and are usually observed. If it is causing neurological symptoms, a surgical option is considered but that decision has to be done in collaboration with his neurologist and neurosurgeon.
Aoa brother i am farooq from pakistan. I am suffering cvst since july 2017. I have got latest test of MRI brain, CT scan etc. kindly send your watsap so that i could send my report to you
I am sorry that you are suffering with CVST. Unfortunately it’s challenging (and dangerous) to offer treatment advice based on reports/scans without evaluating a patient in person. I suggest you see a neurologist near you for a proper evaluation.
Y’all do a fantastic job presenting these topics in a case-based, logical way. I send all my neurosurgery students to your channel and this is a great addition! Please keep on putting great medical education out there for free for students. It’s going to make a big difference educating the next generation of docs/PA’s/NP’s.
I suffer from autoimmune meningoencephalitis (non-infectious) caused by meningoradiculitis ( nerve root meninges inflammation). My body now has trouble regulating normal CSF pressure, especially when changing positions. I suffer from thunder clap headaches often. I am in so much pain i am unable to move or ask for help. Arachnoiditis (meningitis) can cause this by damaging CSF pressure regulation. Spinal sanitation problems. The most common cause of spine and brain inflammation aka meningoencephalitis. Waste accumulation causes body to attack itself and when inside the, brain and spine, this can form lesions on various neurological systems as well as intracranial hyper and hypo tension symptoms. Spinal fluid flow obstruction is a likely contributer to thunderclap headache as well. Mechanical meningitis is one of three known causes of meningitis. Infection and chemical are the other two. Examples of mechanical meningitis is genetics, cysts i.e. tarlov, and physical damage like slip disc. Modern misconceptions ignore mechanical meningitis like i am diagnosed with. I found most doctors incorrectly defined meningitis as an infection not inflammation. My spinal and brain inflammation aka meningoencephalitis was ignored until it was self evident. By then it was too late for me. Infection is one of three known causes of meningitis. Not meningitis itself. Someone may have an infection in spine without inflammation ( meningitis). There is nothing in science that states meningitis is an infection but can be caused by infections, chemicals, and mechanical (i e. Genetics or physical damage). Please i have suffered greatly due to this misconception and ask for scientific accuracy. OVERVIEW OF ACUTE AND CHRONIC MENINGITIS www.ncbi.nlm.nih.gov/pmc/articles/PMC7132757/
I am sorry to hear about your illness. We certainly teach our medical students that meningitis can be caused by infection, inflammation or even malignancy.
Thank you for the great videos! But meningitis and encephalitis is inflammation not infection. Infection is one of three causes of meningitis (inflammation of spine)and/or (inflammation of brain) encephalitis. www.ncbi.nlm.nih.gov/pmc/articles/PMC7132757/ I am currently diagnosed with non-infectious autoimmune meningoencephalitis. The initial cause was mechanical meningitis called meningoradiculitis aka Symptomatic tarlov cysts ICD G96.191(nerve root inflammation). I hope this helps. It is now officially a central nervous system disorder not mere radiculitis. According to a peer review article on meningitis, genetic causes are classified under mechanical causes same as cysts that are known to be causes as well according to meningitis article provided. It is also one of the most referenced papers on the topic of meningitis. My MS doctor from NYC recommends it as well. Since I developed autoimmune meningoencephalitis as a symptom I started seeing neuro immunologist. I also developed trigeminal neuralgia and hypoglossal pharagneal neuralgia as damage climbs my spine. My heart beats as low as 35-45 beats a minute now. I found my MS doctor by doing a search for autoimmune encephalitis online and the computer gave encephalitis web site and the MS doctors. Not only that arachnoiditis is a synonym for meningitis. Icd G03.9. Of which I am being treated for. This misconception of meningitis being an infection I found to be dangerous and biggest cause of misdiagnosis. I had to travel with research to quickly teach emergency room departments in NYC to treat autoimmune meningoencephalitis flare ups emergencies. Being scientifically misdiagnosed and under diagnosed made my condition severely worsen. Demyelination and nerve fiber fatigue is a huge problem and now I use a mobility device for medical assistance. This all started as a symptomatic tarlov cyst aka meningoradiculitis (nerve root inflammation).
Unfortunately you and everyone else :). The short version: SAH causes decreased compliance of the intracranial contents impeding normal CSF circulation and absorption.
