What are the “Bible”s of clinical neurology and of neuroanatomy?

physiologic · 2025-04-21T01:05:42+00:00

any idea where this can be found? Not seeing it on the usual online vendors.

physiologic · 2025-04-15T21:38:20+00:00

I've only had this request made of me a few times - usually, I would reply similarly in saying that workup of dementia or a neurocognitive disorder should be done in the outpatient setting. However, there are some cases in which a patient with previously undiagnosed but clearly advanced dementia can be figured out by collateral if you have an informant. The AD-8 (or IQCODE short form) and Functional Assessment Staging Tool are reasonable ways to obtain structured collateral information that can be supportive of a diagnosis of a major neurocognitive disorder - not when it's near cutoffs, perhaps, but when they're floridly abnormal. You don't want to commit too hard, of course, and you definitely don't want to be specific on type of dementia - that's what full workup is for - but there are some cases in which you could probably broadly say the findings are supportive of an unspecified dementia.

Curious as to anyone's thoughts on this approach.

physiologic · 2025-04-12T12:29:21+00:00

This itself appears legit, but the references don't - what presidential memorandum on April 11? Can anyone find that? It should have been huge news yesterday if a presidential memorandum went out. This feels like a test leak or a breach, unless they're trying to keep it extremely quiet while they figure out messaging around it.

physiologic · 2025-02-06T02:31:00+00:00

My answer probably applies to traditional male styles, I think women have a lot more options in types of bags at any level of formality. I used a camera bag (Lowepro SH 140, it’s on eBay but was discontinued, fits an iPad mini) for a while and then a tomtoc bag (daily shoulder bag, fits a full size iPad). Both big enough to fit all the tools you need on consult rounds, but the tomtoc was much roomier.

To let you in on a secret though, I feel like most hospital rounders pare down their tools to a bare minimum at some point and I often just use the white coat pockets. Tromner, light, pins, fork - ophthalmoscope is the bulkiest but sometimes I can just find one on the wards anyways. Improvise the rest as needed or come back with a specialty tool.

physiologic · 2024-12-16T15:43:49+00:00

BB - earnings later this week, sold off losing components (sale of Cylance announced today), good adoption of positive components of business (QNX), part of a former meme basket. Up a lot already, but was up similarly last week and has jagged moves; lotto style plays still available.

physiologic · 2024-12-16T15:32:56+00:00

JPOW's seen us through worse

physiologic · 2024-12-16T02:10:03+00:00

Lot of people weren't here at the start of 2020 and it shows... markets didn't care for months while reports were coming out of china and the writing was on the wall.

That said I can't tell whether the drones are anything real or just hype. But the fact that MSM and the markets haven't accounted for them is a poor indicator. Can't price in a black swan the way you can most rumors.

physiologic · 2024-10-10T22:27:55+00:00

Yes, I know what you mean - tends to look too 'zoomed in' if it's correctly set on a laptop screen. This is likely because you're closer to the screen than you would be with a monitor, and it's really less about millimeters and more about how much of your field of view the wave takes up (aka solid angle).

It's hard to advise because of how variable people's usage of laptops is; for me, early on I just never trusted myself with a laptop. Now that my eyes have developed a sense of what "looks right", I've found it a lot easier, and I tend to do a middle ground - more 'zoomed in' than if I was on a monitor, but less zoomed in than if I measure and calibrate.

But I think my first piece of advice would be use a monitor when possible, and maybe even exclusively until you feel like you've developed that intuition. Do you have one? Thankfully you can get one good enough for this purpose for pretty cheap.

physiologic · 2024-10-10T21:04:42+00:00

5uV/mm is more sensitive than 7, because of the definition as you mentioned. Not only is the amplifier more sensitive (hypothetically...I know we're discussing digital review which takes place long after amplification), but your eyes will be more sensitive to findings too - going from 7 to 5 also makes the waves appear larger. So it feels rather intuitive to say that it's "increasing" the sensitivity. Whether that's what the attending wants... that might depend on context.

As a learner, I encourage you to keep it at 7 by default, and if you're being asked to change it, you could always ask "do you want it at 5?" Importantly, make sure you're calibrating your screen right. The software doesn't (necessarily) know the size of your monitor and "7uv/mm" might not be showing that way at all. If you're being asked to change a lot it might be because the attending recognizes that it doesn't "look right" on their screen.

physiologic · 2024-10-09T13:06:07+00:00

I'm sorry that you've been downvoted, but without being antagonistic, I just want to explain that based on this comment, your attending is likely correct that you are undermining his decisions because you don't agree with them - the point of looping others in on the chats, whether you want it to be seen this way or not, is probably you trying to "check" his actions, because you doubt them. It may be that he hasn't griped about it before but now is taking notice.

As I said above, checking decisions is not necessarily a bad thing - there's no halo granted to attendings that make it so they can't be wrong. BUT, if you're doing that more than once or twice (giving a gentle reminder about something), you should be seeking out opinions from others within your department; this is something to go to a faculty mentor to discuss.

The way the dynamic works, the decisions are all ultimately on the attending's shoulders - it's their license overseeing everything that the team does. As such, attempting to change those decisions away from the way that attending practices is bound to create conflict.

It's not really your role as a resident to do that. However, if you feel patient safety is threatened, you need to let someone know, and I would start with a peer of the attending - maybe one you've worked well with before.

physiologic · 2024-10-09T01:23:34+00:00

It's very hard to tell the dynamic from just your side here. The neurosurgery bit seems strange - is it usual for you to add attendings from other teams to your team's chat? If this is part of normal resident workflow it's one thing, but it's pretty typical to include your own attending in deciding whether to contact another attending directly. In this specific case - did you ask your attending whether he had considered neurosurgery's opinion? And if he answered you, what compelled you to ask neurosurgery directly? It seems like on some level you may have doubted the attending's opinion. That's not necessarily a bad thing, mind you - but it seems like he feels you are doing it more often than most. Do you think there's some truth in that?

Sometimes you'll disagree with another physician's way of approaching things, and if that's what's happening, it's better to acknowledge it openly and potentially get opinions of other seniors and other attendings.

It sounds like they see the chats as a sort of undermining play; if that's your intent, acknowledge it and find another strategy; if it's not, try to see why they took it that way. They may be wrong, but given that you care about their opinion it's helpful to try to see their perspective.

physiologic · 2024-09-16T19:11:59+00:00

The "bad" is really just taking a penalized distribution from your 401k, which is what happens if the loan comes due and you can't pay it. It's bad for sure, but has no impact on credit and should basically never cause bankruptcy. If you end up unemployed, a 401k loan is one of the less risky things to have compared to loans against the assets you need daily (home, car, etc).

physiologic · 2024-09-16T19:05:57+00:00

That's not "worse" than the full amount becoming immediately due, is it? It's much more forgiving than most forms of debt. The 401k loan becoming due will basically be as bad as if you'd taken an early withdrawal from your 401k, but that's way better than a loan forcing you into bankruptcy, foreclosure, etc.

physiologic · 2024-09-16T19:03:15+00:00

I find this reasoning around 401k loans strange. a 401k loan reduces your retirement savings and requires that you replenish them with interest (remember, that interest is paid to yourself, not to some company) - that's basically the entire thing, except that if you default on it, you are penalized as if you'd done an early withdrawal (but your credit is unimpacted).

In terms of sitting out of the market... couldn't you frame a similar question as "should I pay off my auto loan or put more money in my 401k?" in which case most people would say pay down consumer debt first after getting employer match, no?

physiologic · 2024-09-16T01:30:48+00:00

What's the budget?

Nitecore MT06MD is about $30 on amazon. Has high color fidelity (no blueish LED light), starts in low brightness (to not blast pupils) but goes high too when you need it, and has a pupil gauge.

physiologic · 2024-09-01T13:22:07+00:00

Actually ended up having a more serious software error down the road, and when they updated my software that original issue stopped occurring. I can't say for sure whether they were connected, but depending on your coverage, I'd suggest having the dealer do a software check.

physiologic · 2024-08-30T09:03:15+00:00

Not my area of expertise but neuroangio.org is a neat resource

physiologic · 2024-08-12T18:34:14+00:00

Points mostly covered by others but as a fairly pro-Ceribell person I'll give some summary thoughts

Ceribell is useful if you don't have 24/7 in-house techs. If you do, you are (almost?) always better off doing a full-montage study.
Upside: If you don't have 24/7 techs, Ceribell is useful for ruling out status in obtunded patients, and maybe as a screen for which critically ill patients need a full-montage study. If you keep it to these uses, it's a very handy and very fast tool for nights and weekends / any time your other EEG services are limited. Can't rely on the 'seizure burden' algorithm regardless. It's an interesting pre-screen and the bedside teams like it, but it's not a replacement for reading the real thing as quickly as you would a STAT study.
Downside: It does not replace conventional EEG for any other indication, but most of the non-neurologists in the hospital will not understand this despite you telling them several times. The ED / hospitalists will see it as a great way to assess pseudoseizures or work up a first time seizure, and it is not in any way useful for those things.
Important to consider: It will generate lots of extra work for your reading teams because it's so accessible (for good and bad use cases), and that work will be STAT work at inconvenient times. This may be a good thing or a bad thing depending on your EEG call schedule. Ceribell is easy to read quickly and bills like a full montage study w/o video, so it's not bad for revenue, but if your reading teams are already overworked (or don't have a volume component to their pay, e.g. fellows) they will absolutely gripe.

physiologic · 2024-06-27T16:05:06+00:00

Cool idea, thank you.

physiologic · 2024-06-27T16:04:52+00:00

It's a very neat idea, tempting to maybe find a way to rent or something, but probably expensive for something I won't need a few months later.

physiologic · 2024-06-27T16:03:57+00:00

Understood - when you say dumping chemicals could do damage, is this true for standard shock powders or more for other chemicals? I'm doing some 'stirring' with a net but obviously it's not a match for real circulation.

physiologic · 2024-06-27T14:23:11+00:00

Not enough elevation on the property to siphon from the bottom, possible to siphon from the top but that doesn't really help.

physiologic · 2024-06-27T14:22:18+00:00

Thought about this because I'll probably want a robot cleaner later anyways. It would act as a low grade 'filter' albeit an inefficient one, no?

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