In this next episode in the movement disorders and Parkinson’s disease series, we begin with a brief overview of the mechanisms of action of the medications used to treat Parkinson’s disease, before focusing on five common and important ward dilemmas encountered in the management of patients with Parkinson’s disease: (1) the patient is unable to take their oral antiparkinsonian medications, (2) the patient is psychotic or delirious, (3) the patient has autonomic instability/dysregulation with orthostatic hypotension +/- supine nocturnal hypertension, (4) the patient is frozen/in an ‘off’ crisis, and (5) the much-feared Parkinson-hyperpyrexia syndrome. We discuss pragmatic ways to tackle each of these problems, coloured with analogies and detailed explanations to make the content understandable in a structured manner (and hopefully also memorable!). This episode is suitable for anyone caring for patients with Parkinson’s disease, although it should be especially useful for junior doctors covering the wards on evening/night and weekend shifts (and medical students also about to find themselves in this position)!

#medicaleducation #doctor #parkinsonsdisease #movementdisorders #rneurologyeducation

We’re thrilled to announce the first episode in our movement disorders & Parkinson’s disease series (also continuing our clinical method series), beginning with a discussion of how to perform an extrapyramidal examination, particularly in the context of suspected Parkinson’s disease, progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD; or corticobasal syndrome, CBS), dementia with Lewy bodies (DLB) and normal pressure hydrocephalus (NPH), as well as assessing treatment responses to levodopa and other Parkinsonian therapies to distinguish an excessively ‘on’ or dyskinetic state, from a ‘good on’ state, from an ‘off’ state including a frozen state. As always in Riisfeldt Neurology Education, we provide a clinical focus to help contextualise the information, peppered with tips and tricks to optimise your examination techniques, and hopefully providing a structure to your learning, along with helpful mnemonics in order to aid memorisation. This episode is appropriate for medical students, junior doctors, physician and neurology trainees, and general practitioners (family doctors) and emergency physicians and their respective trainees, and any other health professional assessing patients presenting with extrapyramidal symptoms and signs or with a pre-established diagnosis such as Parkinson’s disease.

#meded #doctor #parkinsonsdisease #clinicalskills #rneurologyeducation

The second episode in the neuro-otology and vertigo series takes a step back to review the clinical approach to the patient presenting with the notoriously misinterpreted symptom of ‘dizziness’, before reviewing the best way to classify common causes of vertigo into either acute persistent vertigo vs. episodic vertigo (which can in turn be triggered vs. non-triggered). It then discusses the diagnosis and management of vestibular neuritis, benign paroxysmal positional vertigo (BPPV, especially the posterior and geotropic/ageotropic horizontal canal variants), Meniere’s disease and migraine with vestibular features, before turning to a discussion of less commonly encountered causes of vertigo so as to provide an exhaustive list of the potential causes of vertigo, so that when you encounter them in clinical practice you are not then hearing about them for the first time. As always, the episode is packed to the rafters with useful tips, tricks and personal and practical insights so as to contextualise the content, in an attempt to aid structured understanding and memorisation. This episode is appropriate for medical students, junior doctors, physician and neurology trainees, neurologists, cardiologists/ general practitioners (family doctors)/emergency and intensive care physicians and their respective trainees, and any other health professional assessing patients presenting with dizziness (who may ultimately have a neurologic, cardiac or another cause for this presenting symptom).

#MedicalEducation #Doctor #Vertigo #Dizziness #RNeurologyEducation

We’ve got another surprise installed for you today… the first episode in the neuro-otology and vertigo series! (Again as an overlap with our ongoing clinical method series). This episode focuses on the HiNTs+ examination in distinguishing central from peripheral causes of an acute vestibular syndrome, in particular distinguishing a posterior circulation stroke (of the brainstem or the cerebellum and its connections) from vestibular neuritis. The episode then changes tack to discuss the Dix-Hallpike examination and then the horizontal head roll (log roll) tests to diagnose posterior canal and geotropic/ageotropic horizontal canal BPPV (benign paroxysmal positional vertigo), respectively, and it also discusses the Epley manoeuvre and barbeque roll (BBQ roll; Lampert roll) manoeuvre in the treatment of posterior canal and horizontal canal BPPV, respectively. As always, the episode is packed to the brim with helpful tips and tricks to help you perform these examinations and techniques optimally and efficiently, along with suggestions to help remember them! This episode is appropriate for medical students, junior doctors, physician and neurology trainees, neurologists, cardiologists/ general practitioners (family doctors)/emergency and intensive care physicians and their respective trainees, and any other health professional assessing patients presenting with dizziness (who may ultimately have a neurologic, cardiac or another cause for this presenting symptom).

#medicaleducation #doctor #vertigo #clinicalskills #rneurologyeducation

This is the first episode in the neurological procedures series… drum roll please… you guessed it, it’s the lumbar puncture (LP)! This episode describes at length the many indications for lumbar punctures (a super helpful procedure!), the contraindications and how to evaluate these, how to consent the patient, what equipment is required and recommended, different options for ways to perform the procedure, and then of course a step-by-step how-to guide including invaluable tips and tricks, to hopefully improve all of your abilities in performing this essential procedure. The episode then concludes by providing a logical way of grouping and remembering all of the laboratory tests that may be required on the cerebrospinal fluid (CSF) specimen… and don’t forget the paired serum testing! This episode is appropriate for medical students, junior doctors, physician and neurology trainees, emergency/critical care trainees, and any other health professional wanting to learn how to become awesome at performing lumbar punctures.

#medicaleducation #doctor #clinicalskills #lumbarpuncture #rneurologyeducation

Correction: 19:30 Visual threat testing is for testing visual fields when the patient isn't properly responding to your initial standard field testing (not for when there is already an established field deficit in a cooperative and responsive patient)

Correction: 21:31 Should say "retrochiasmal components" (not "upper motor neuron components", oops!)

Correction: 45:56 Same as for my initial correction

We’re very excited to present the first episode in the stroke and cerebrovascular diseases series! (As an overlap with our ongoing clinical method series). This episode focusses on how to perform a NIHSS hyperacute stroke examination accurately and quickly, and explains the rationale behind each item, how to examine each item correctly, and tips for remembering the NIHSS items, in order to better prepare you for your next stroke call/code stroke.

#meded #doctor #stroke #nihss #rneurologyeducation

This episode further continues our clinical method series by turning to the lower limb examination, focussing on tips and tricks to optimise your examination technique assessing inspection, tone, power, reflexes, sensation, coordination, stance and gait. The diagnostic utility of many of these examination components are critically discussed, and various pearls and pitfalls are highlighted, along with linking the examination to relevant clinical presentations in order to form mental connections and aid memorisation.

#medicaleducation #medicalstudent #clinicalskills #neurology #rneurologyeducation