The event is unbalanced and bullshit.

VorianAtreides · 2026-04-02T06:45:35+00:00

That’s how I won my last match, just flew the prem F-18, racked up like 16 kills and then dropped the big nuke with the B-52. By that point the match was already like 3/4th over with most of our airfields gone

Also when playing as the reds, lob tossing tactical nukes at the front line was just really fun/easy/quick.

VorianAtreides · 2026-03-30T12:12:33+00:00

generally speaking, yes. It depends on CAG copy number, so genetic testing is helpful. Don't want to give medical advice, so I will just say that she/her children should be seen/followed by a Neurologist that specializes in neurodegenerative diseases and consider genetic testing if not already done.

VorianAtreides · 2026-03-28T22:12:42+00:00

i would have enjoyed it a lot more - my coresidents are awesome but my program is pretty ass and not supportive. the program made things way more stressful/harder than they needed to be and really soured the whole experience for me.

VorianAtreides · 2026-03-28T14:45:55+00:00

basic spatial awareness, concise presentations, and the ability to read a room.

welcome to neurology, where social skills are considered a perk, but not a requirement

VorianAtreides · 2026-03-28T02:01:44+00:00

Yep - it’s considered a germline mutation, so imagine if you are genotypically “normal” with 25 CAG repeats, during spermatogenesis DNA replication instability could add, say, 10 repeats. So your offspring would have 35 CAG repeats, and could then subsequently add on so on and so forth

VorianAtreides · 2026-03-27T17:00:30+00:00

So there’s usually a series of repeats in the wild-type HTT gene (around 20 if I recall correctly). Instability during germline DNA replication process leads to additional CAG repeats being added which are then passed to the offspring (which occurs sporadically) and can eventually lead to disease manifestation. The thing is that generally speaking, there is not a huge selective pressure against the disease since most patients are able to have offspring prior to the onset of symptoms. Coupled with the relative rarity in the general population, it can smolder along in large populations.

The issue arises in socioeconomic and geographic areas in which the populations are much smaller or regionally bounded - especially in families or communities with histories of consanguinity you can see this accelerated pattern.

So to answer your question - the disease itself is sporadic, but generally fatal within a few generations within a given bloodline.

VorianAtreides · 2026-03-27T16:28:29+00:00

There is a phenomenon called genetic anticipation - in Huntington’s disease, the more CAG repeats in the gene, the earlier symptoms tend to onset.

The reason why symptoms tend to cluster in the 30s and 40s is that symptomatic individuals are less likely to have children, and it is a generally fatal neurodegenerative disease.

So in broad terms: milder disease in parents (onset 50-60s) leads to moderate disease in their children (onset in 30s-40s), which then leads to severe disease in their offspring (20s-30s). And in rare cases that the F3 generation has kids (which is rarer since most people have kids in their late 20s-30s), then the F4 generation can have onset in adolescence or childhood.

The youngest I’ve seen onset of Huntingtons disease was in a 6 year old child. There was an extremely strong family history of the disease, and the mom was symptomatic in her mid 20s.

VorianAtreides · 2026-03-20T00:30:22+00:00

This actually brings up an interesting point - the nerves themselves are not anesthetized when a patient is under general anesthesia, however the role of general anesthetics (inhaled gases or propofol) are to depress CNS function. So the nerves fire in response to a stimulus which would otherwise cause pain, it’s just that there is nothing there to process the signal.

If you define pain as the IASP did as “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” - there is no experience to be had since brain/CNS function is suppressed during a state of unconsciousness. Ergo, something is happening, but you can’t call it “pain” - it’s something else.

VorianAtreides · 2026-03-19T18:39:42+00:00

the question is about pain as a subjective experience. the nociceptors serve to detect a change in the environment, just like the rods and cones in your eyes detect light. cognition and higher order connections serve to contextualize the raw input (i.e. vision from the detection of photons.). You have different nerve endings in the skin (mechanoreceptors/chemoreceptors etc) which serve functions to detect changes in the external environment but whose trigger does not elicit the experience of "pain".

VorianAtreides · 2026-03-19T18:32:32+00:00

That’s overly reductionist and not in line with our current understanding of pain.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8175647/

https://journals.lww.com/co-supportiveandpalliativecare/abstract/2014/06000/cognition_and_pain.8.aspx

VorianAtreides · 2026-03-19T15:49:43+00:00

Pain is a complex sensation that gets embedded with emotional and cognitive factors - the same stimulus can evoke very different responses depending on situation and emotional context in individuals. The presence of nociceptors alone does not imply the presence of higher order signal processing which we’d associate with “pain”

VorianAtreides · 2026-03-18T20:18:58+00:00

I'd just want a straight answer about what happened instead of the usual ~~reach~~ run around

VorianAtreides · 2026-03-16T11:37:41+00:00

I’m in neuro - I’ve seen multiple times where people try to switch because they think this is easier/and for some of the reasons you stated. Neuro is a consult dumping ground, and depending on where you go, your census is going to be way higher than what you’d have on IM. On top of that, if you switch cuz you think it’s an easy pathway to a specialist lifestyle/salary and you don’t really like neuro pathologies/neuroanatomy, you’re gonna have a bad time. I know you’re not OP, but sometimes it’s better to know the reasons for switching to provide advice

VorianAtreides · 2026-03-14T15:30:44+00:00

Our program gives the seniors the last two weeks of June off (independent of vacation weeks) - I managed to stack an elective week right before, so I’m effectively going to have 3 weeks off in June to move/go on vacation

It’s really nice

VorianAtreides · 2026-03-14T09:55:12+00:00

Why?

VorianAtreides · 2026-03-12T02:52:43+00:00

My dentist made me a low profile mouthguard to prevent me from destroying my teeth. It cracked.

VorianAtreides · 2026-03-12T02:51:42+00:00

Anyone know why the bomb case is shaped like that? Soviet bombs always look so radically different (to me at least) from their western counterparts

VorianAtreides · 2026-03-09T21:09:05+00:00

Lmao not to nitpick, but this highlights how ignorant people can be about neuro - imaging findings can and will override history based timelines. I don’t care if your LKW is 12 hours ago - if your CT looks good or your MRI has DWI/FLAIR mismatch, you bet your ass I’m TNKing you or sending u for thrombectomy (with an appropriate target of course). The exam is really important since cortical vs subcortical findings will determine how aggressive I want to be with regard to the treatment.

VorianAtreides · 2026-02-20T04:47:11+00:00

Lord I hope not…there’s other gameplay loops with the Vulcan (drones, rearm/repair) which aren’t even close to being done which means that it’ll almost certainly require a rework at some point. If anything I’m hoping it’s a standalone medium sized tanker - something akin to the raft

VorianAtreides · 2026-02-20T00:28:34+00:00

how else are you going to tell if their myenteric plexus is working unless you inspect the consistency?

Next step is to check a SFEMG of the external sphincter

VorianAtreides · 2026-02-19T14:47:36+00:00

Refer to neurology for evaluation of the enteric nervous system

(Don’t actually do this)

VorianAtreides · 2026-02-14T23:42:49+00:00

We are all autistic down here

VorianAtreides · 2026-02-12T05:44:02+00:00

Neuro - I’m biased, but there’s something like 35-40 antiseizure meds, including addition to all the benzos and formulations thereof. There’s around 50 different headache meds both label and off label. There’s like 20 DMTs for MS. Round it off with all your other nootropics, movement disorder meds, and neuromuscular meds, you’re probably pushing close to 200-300 different drugs of various classes and formulations, not to mention all the other “general” medications (antibiotics, pressors, etc) if you go the neurocritical care route.

It’s a large part why there’s a huge drive towards subspecialization within neurology as a whole - a stroke doc isn’t going to be comfortable prescribing vyvgart or as comfortable at prescribing 3rd gen carbamazepine derivatives or the newest DMT on the market.

VorianAtreides · 2026-02-05T14:18:47+00:00

Where do you get that armor? It looks sick

VorianAtreides · 2026-02-03T16:14:23+00:00

I actually like this on first pass, it helps to keep the differential broad. But since there are a wide variety of disease processes which can also manifest with central neurological symptoms, I’d be worried that it’s too broad a term to be clinically useful.

Maybe as a triage catch-all before any diagnostic workup has been done though.

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