Micah Etter, MD

1/ Hello #medsky #neurosky #neurocritcare #FOAMEd have a brief case that I wanted discuss with you and see if maybe you can learn something new or reinforce old knowledge!

Image Challenge What is the diagnosis? Upper left: MRI of the brain showing diffuse pachymeningeal enhancement. Lower left: A computed tomographic myelogram. Right: MRI showing protrusion of the cerebellar tonsils into the foramen magnum (tonsillar ectopia), flattening of the pons with effacement of the prepontine cistern, and enlargement of the pituitary gland owing to increased blood flow.

A 50-year-old woman presented to the emergency department with a 10-day history of a throbbing headache that had suddenly started after she had felt a “pop” in her back. The headache worsened with upright positioning and improved with lying flat. 1/4

#MedSky

Just the facts: rivastigmine for the management of anticholinergic toxicity - Canadian Journal of Emergency Medicine Canadian Journal of Emergency Medicine -

Case series w/ cumulative total n=110 pts support use of rivastigmine as alternative antidote to physostigmine for anticholinergic delirium. Both oral & transdermal formulations of rivastigmine may expedite recovery #medsky #EMsky #pharmsky #emimcc #FOAMed

👉 link.springer.com/article/10.1...

OpenEvidence is generally very good, but it's occasionally horrifically wrong

One place it falls down a lot is drug allergy (where it's often too conservative)

There are NO absolute contraindications to acetylcysteine for acetaminophen OD

Reported "allergy" = anaphylactoid rxns... (#1/3) #EMIMCC

Prodromal phase of multiple sclerosis: evidence from sickness absence patterns before disease onset – a matched cohort study Background We aimed to investigate the prodromal phase of multiple sclerosis (MS) by investigating annual sickness absence rates before MS onset. Methods A retrospective cohort study was conducted us...

You had MS even before you had symptoms. This study found increased absenteeism from work 6 years prior to diagnosis. jnnp.bmj.com/content/earl...

This is what we were waiting for. A direct comparison between apixaban and rivaroxaban for the treatment of acute VTE. Apixaban reduces bleeding risk in the first 3 months by >50%!

Practice changing investigator-initiated RCT.

#ISTH2025

A web-comic that says "A Simple Guide to Using AI in Peer Review" with one panel that says "Wrong Way" and the next panel says "Right Way."

Peer review is being transformed by AI, whether we like it or not.

From my own experience, most researchers are using it wrong… and that’s because no one’s talking about it! Let me share some ideas on how to harness its potential to improve scientific publishing.

Herpes Zoster Vaccination and Dementia Occurrence

Herpes zoster vaccination eligibility reduced the probability of new dementia diagnoses, suggesting its potential preventive effect.

https://ja.ma/4lagSB6

What is the prevalence of elevated opening pressure in children with Alexander Disease?

In the current issue of #pedneuro journal, Joung et al. explore this question through analysis of opening pressure, MRI and examination in a cohort of 43 patients.

Read Here: buff.ly/UrvyLjh

INDEX trial: CT perfusion wasn't adequate for evaluating brain death.

huge problem: they're using clinical exam as the gold standard

I think most patients classified as brain dead by CT perfusion but alive by exam were dead... #1/2

#EMIMCC #CCR25

Diagnostic performance of plasma p‐tau217 and Aβ42/40 biomarkers in the outpatient memory clinic INTRODUCTION Plasma biomarkers of Alzheimer's disease (AD) represent accessible alternatives to positron emission tomography (PET) and cerebrospinal fluid (CSF)-based biomarkers in well-characterize.....

"Plasma p-tau217 reliably identified clinic patients with Alzheimer's"🆒

"definitive results in 86% of patients" 🆒

"Integration of plasma Aβ42 minimally improved diagnostic performance"🐟

"Plasma p-tau217 levels were increased in patients with kidney dysfunction"🫘

ICH Calculator One Stop Shop

🚨 Excited to announce my brand-new, all-in-one ICH calculator page! It brings together multiple intracerebral hemorrhage stroke calculators in one comprehensive spot for assessments + decisions. 🧠🩸

Explore, use, share, and REMIX!💿📼
Check it out here: tinyurl.com/ICHcalc

#ThrowbackThursday to our episode on DAPT 🩸

Did you know that ticagrelor inhibits adenosine reuptake, which can cause bradycardia and dyspnea, sometimes resulting in patient self-discontinuation ‼️

www.coreimpodcast.com/2021/04/07/5...

The Journal of the American Medical Association, Vol XXXIX, Chicago, Illinois, November 8, 1902 Addresses. Memorial to the late J.T. Eskridge, M.D., of Denver, Colo. Chairman of the Section on Neurology of the American Medical Association. Charles K. Mills, M.D. Philadelphia and Frank P. Norbury, M.D. Jacksonville, Ill.

For reasons, I was reading the 1902 memorial of early American neurologist J.T. Eskridge this morning - and Frank Norbury has some delightful thoughts on enthusiasm that I thought I'd share 1/5

The New England Journal of Medicine Oveporexton for Narcolepsy Type 1 A Research Summary based on Dauvilliers Y et al. | 10.1056/NEJMoa2405847 | Published on May 15, 2025 Visual representations of the patients in the trial and the treatments they were assigned. Read the full Research Summary at NEJM.org.

In the TAK-861-2001 trial involving 112 participants with narcolepsy type 1, oveporexton significantly improved measures of wakefulness, sleepiness, and cataplexy over a period of 8 weeks. Full trial results and Research Summary: nej.md/3ZdlKNi 

#MedSky #NeuroSky

A recent article seems to imply that we don't need to check an ECG before giving ondansetron.

This is largely correct, but I disagree with some of their points.

I wrote a letter to the editor that I posted in the blog, so you can access it easily here: emcrit.org/pulmcrit/twd... #EMIMCC

Personalized Gene Editing to Treat an Inborn Error of Metabolism | NEJM In this editorial, the authors describe the foundations of an N-of-1 gene-editing study to treat an infant with a urea-cycle disorder.

In a new editorial, Andrea L. Gropman, MD, and Alexis C. Komor, PhD, describe the foundations of an N-of-1 gene-editing study to treat an infant with a urea-cycle disorder. Read the editorial: nej.md/430hLWR

#ASGCT2025 @asgct.bsky.social #ScienceSky

1/ Hi 👋 #medtwitter #neurotwitter #neurocritcare #FOAMed #meded have an impressive image to show you in the form of another case, albeit, this one with a sad ending

Is There Really a Plastic Spoon in Our Brains? Science Vs · Episode

NEW EPISODE: Is there really a spoon's worth of plastic in our brain? A paper came out recently making this claim, and it went viral, tons of splashy headlines. But some scientists are VERY skeptical. 🧪 🧪🧪

Find out why 👇 available wherever you listen

open.spotify.com/episode/2ZwZ...

YouTube video by Dr. Glaucomflecken The Dangers of Raw Milk

youtube.com/shorts/CuSwN... I made some people big mad with this one

For this teacher appreciation week, I’m going to talk a little about graduate medical education.

What is it?

It’s the education of resident and fellow physicians. These trainees have finished medical school & are doctors but need to complete residency +/- fellowship to work in their speciality.

The gylmphatics of our brain, which clear waste products, interact with our immune system and are key to preserving brain health, modulating its aging process, and propensity for neurodegenerative diseases
A superb review @cp-immunity.bsky.social @jonykipnis.bsky.social

Research Discovery: Neurodegeneration in multiple system atrophy (MSA) is caused by toxic protein clumps that penetrate the nuclei of neurons and cause the death of those cells.

Diseases affected: Multiple System Atrophy (MSA)

Key findings: Oligodendrocytes are not the primary cause of MSA, as previously thought.

What's next? By identifying neurons as the primary victims of α-synuclein toxicity, researchers can now develop treatments that protect neurons from invasive protein aggregates or enhance the cells’ ability to clear them out.

A breakthrough in #MultipleSystemAtrophy (MSA) research: Dr. Victor Dieriks and his team in NZ have identified that the cause of this neurodegenerative disorder is toxic α-synuclein protein aggregates that invade neuron nuclei.

buff.ly/YKLxq6O

Despite extensive experience with electrolyte disorders, neither I nor any of 12 experienced nephrologists whom I consulted have ever seen a case of central pontine myelinolysis evolving during the repair of hyponatremia. This broad experience contrasts sharply with the report of Sterns et al. in this issue.

To the older physicians that have attacked me for being part of the contemporary data showing the rarity of central pontine myelinolysis and explain that only because of their success at slowing the correction of hyponatremia has CPM become rare, I provide an editorial by Robert Narins from 1986:

art

“The sky was the color of television, tuned to the Weather Channel.”

Images in Clinical Medicine Hemiplegic Migraine Panel A: The MRI sequence measuring cerebral blood flow indicating hypoperfusion of the left hemisphere that did not match vascular territories. Panel B: Diffusion-weighted imaging showing no ischemic changes, and angiography showed patent vessels.

A 46-year-old woman with a history of migraine with visual aura presented with a 3-hour history of headache, as well as weakness and numbness in the right arm. Read the full case details: nej.md/42kx4tb

#MedSky #NeuroSky

"The Pitt" Scenes Ranked by Medical Bills for the Patients, Therapy Bills for the Providers The American for-profit healthcare system is fucked, and primed to fuck every American who doesn’t have more than seven digits stashed in their bank account.…

"The Pitt" Scenes Ranked by Medical Bills for the Patients, Therapy Bills for the Providers

hard-drive.net/hd/entertain...

1/ Hi 👋 #medtwitter #neurotwitter #neurocritcare #FOAMed #meded have a short case I wanted to share with you and see if perhaps you learn something new!

Dr. Kathryn Krulisky of @uofuneur providing “Updates in Epilepsy” as part of the comprehensive C10 Neurology Update Course at the @aanmember.bsky.social Annual Meeting in San Diego! 🧠

#AANAM