iiinova — where your digital self keeps evolving

Reposted by Casey Albin, MD

Richard Choi, DO, FNCS @rkchoi.bsky.social · 03/09/2025

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

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Neurology Digital Education Collaborative @ndecinstitute.bsky.social · 04/04/2025

Heading to #AANAM? The NDEC #secretmission continues with another chance to win the glial gladiator belt. Join @caseyalbin.bsky.social @jrgoldstein.bsky.social & @drjmartindale.bsky.social Sunday 4/6 for a digital technology tour & receive your mission instructions! #neurosky

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Reposted by Casey Albin, MD

Neurology Digital Education Collaborative @ndecinstitute.bsky.social · 05/04/2025

Join the #secretmission and learn more tomorrow at 7AM for a Technology Tour in the @aanmember.bsky.social education room with @caseyalbin.bsky.social, @drjmartindale.bsky.social and @jrgoldstein.bsky.social

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Casey Albin, MD @caseyalbin.bsky.social · 04/03/2025

Do you care for pts with disorders of consciousness in any capacity (as a MD, RN, social worker, pharmacist, PT, OT, caregiver etc!!)? 👇5 min survey on what educational resources you'd like to see Neurocritical Care Society provide?

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Casey Albin, MD @caseyalbin.bsky.social · 11/03/2025

Curious about RVUs, want to know if you are billing correctly, how about diversifying your revenue stream?? We've got answers from @smuehlsch.bsky.social & Dr. Ryan Hakimi. Save the date! The zoom link is on SCCM connect and will be emailed if you are part of the neuroscience section

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Casey Albin, MD @caseyalbin.bsky.social · 11/03/2025

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Casey Albin, MD @caseyalbin.bsky.social · 04/03/2025

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Casey Albin, MD @caseyalbin.bsky.social · 02/03/2025

Bookmarked for our travel day tmw!! Critical work to define entrustment in NeuroICU APPs!

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Casey Albin, MD @caseyalbin.bsky.social · 20/02/2025

Mark your calendars for Sunday!! Come hang with all the brain nerds😎 in Orlando! Help spread the word! @aartisarwal.bsky.social @drdangayach.bsky.social blob:null/88bed75b-9775-438b-89fb-0597d2f80f4c

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Reposted by Casey Albin, MD

Michael Okun @michaelokun.bsky.social · 26/01/2025

Are we missing cases of ocular telangiectasia and ataxia (walking and coordination) syndrome? YEP. Should these folks avoid X-rays? YEP. Do you know what features these cases may present with at ~age 40. Lukas Gattermeyer-Kell and colleagues show us two key images and teach us all about it.

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Casey Albin, MD @caseyalbin.bsky.social · 10/12/2024

I think this is a reasonable take based on the evidence! Do I really think the grade 1 SAH with a whisp of blood and low risk of DCI needs a Hgb of 9? No. But for pt in clear vasospasm (aSAH but also TBI) or other perfusion disturbing physiology I think I will keep 9 as my threshold.

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Reposted by Casey Albin, MD

Joe Geraghty MD, PhD @joe-geraghty.bsky.social · 10/12/2024

Introducing @JSCVD2's new Medical Education in Vascular Neurology section, welcoming manuscript submissions that share ideas, research, & innovation that enhance #MedEd for stroke & cerebrovascular disease. #neurology #stroke #neurosurgery #neuroicu www.sciencedirect.com/journal/jour...

sciencedirect.com

Announcements - Journal of Stroke and Cerebrovascular Diseases | ScienceDirect.com by ElsevierScienceDirect

Read the latest articles of Journal of Stroke and Cerebrovascular Diseases at ScienceDirect.com, Elsevier’s leading platform of peer-reviewed scholarly literature

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Casey Albin, MD @caseyalbin.bsky.social · 10/12/2024

18/ Interested in how others are interpreting these results. Again, huge congrats to the authors. and a special shout out to Dr. Ofer Sadan who led the SAHARA effort at @emoryneurocrit.bsky.social @ericclawsonmd.bsky.social @pulmcrit.bsky.social @aartisarwal.bsky.social @ajwpharm.bsky.social

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Casey Albin, MD @caseyalbin.bsky.social · 10/12/2024

17 I think there is enough data to suggest that aiming for 9g/dL PARTICULARLY (maybe exclusively) in pts at ⬆️ risk for decreases in cerebral perfusion due to ongoing physiologic changes like vasospasm makes sense given the control population in this trial & the results of TRAIN

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Casey Albin, MD @caseyalbin.bsky.social · 10/12/2024

16/ The way I have put this together, is that I will be more aggressive (than the standard 7 or what we have allowed as 8g/dL) in transfusions for the patients at highest risk for secondary neurologic injury.

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Casey Albin, MD @caseyalbin.bsky.social · 10/12/2024

15/ It seems to me a take away is that 10g/dL is too high to offer benefit, but the lowest acceptable number I think is still up for debate, and TRAIN would suggest 9g/dL might be a more reasonable target. Indeed, the restrictive group in SAHARA was on average > that threshold

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Casey Albin, MD @caseyalbin.bsky.social · 10/12/2024

14/ In other neurocritically ill pts including SAH (the recently published TRAIN trial), we did reduce unfavorable outcomes when we set the "liberal" threshold of <9g/dl and restrict all the way down to <7g/dl. This looked at 6 month outcome.

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Casey Albin, MD @caseyalbin.bsky.social · 10/12/2024

13/ This trial was very well done and is pragmatic and generalizable. The threshold of 10 doesn't seem to improve neurologic outcomes. However, I don't look at this trial and think that we conclude that maintaining a daily hgb of 8g/dl is proven ok.

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Casey Albin, MD @caseyalbin.bsky.social · 10/12/2024

12/ Between these two groups, there was no significant difference in mRS at 12 months and the risk of having a poor outcome.

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Casey Albin, MD @caseyalbin.bsky.social · 10/12/2024

11/ Note also that once the liberal group got transfused they also mostly stay well above even the liberal threshold. So intervention was transfusion for a low threshold of 8g/dl ... but we're I think ultimately comparing outcomes for avg daily hgb of ~11g/dL to ~9.5 g/dL

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Casey Albin, MD @caseyalbin.bsky.social · 10/12/2024

10/ However, while the two group are clearly different, its important to note... the restrict group was on avg above 9 g/dl. Said differently the controls were anemic, but did not linger 8g/dL threshold... so, the intervention, if needed, got them well away from the "danger" level

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Casey Albin, MD @caseyalbin.bsky.social · 10/12/2024

9/ The median time before enrollment was 3 days (meaning by day 3 the hgb dropped below 10). this is important as it is right before patients would enter the period of highest risk for vasospasm and DCI. And the separation of hgb levels was well differentiated between the groups

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Casey Albin, MD @caseyalbin.bsky.social · 10/12/2024

8/ The groups were well matched in terms of gender, age, WFNS scale, modified Fisher grade. Most had anterior circulation aneurysms, and most were rapidly treated endovascularly. Radiographic vasospasm was seen in 36.6% of liberal strategy and 35% of restrictive strategy pts

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Casey Albin, MD @caseyalbin.bsky.social · 10/12/2024

7/ Everything else about the management was determined per the treating team. And remember, there is variability between institutions about BP goals, how frequently IA is performed, how DCI is screened for, and how meds like milrinone and intrathecal nicardipine are used.

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Casey Albin, MD @caseyalbin.bsky.social · 10/12/2024

6/ And given this and other studies on the importance of anemia avoidance, surveyed neurointensivists, neurosurgeons, and intensivists felt that a threshold of 8g/dL was a more acceptable lower limit than waiting until 7g/dL to transfuse. So 8 it is.

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Casey Albin, MD @caseyalbin.bsky.social · 10/12/2024

5/ wait wait wait.... in other critical care situations we use a threshold of 7g/dL for transfusion... why wasn't this the threshold? Because prior studies have suggested anemia adversely affects cerebral oxygenation and metabolism after aSAH. pubmed.ncbi.nlm.nih.gov/26195087/

pubmed.ncbi.nlm.nih.gov

The Effect of Packed Red Blood Cell Transfusion on Cerebral Oxygenation and Metabolism After Subarachnoid Hemorrhage - PubMed

PRBC transfusion resulted in PbtO2 improvement without a clear effect on cerebral metabolism prior to SAH.

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Casey Albin, MD @caseyalbin.bsky.social · 10/12/2024

4/ Patients were randomized if their Hgb dipped below 10g/dL within the first 10 days of the aSAH admission. Liberal transfusion, you get a transfusion if you fall below 10. Restrictive group, your hgb must fall below 8g/dL before transfusion.

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Casey Albin, MD @caseyalbin.bsky.social · 10/12/2024

3/ Understanding that anemia is frequent. The question was does that impair oxygen carrying capacity exacerbate DCI or other neurologic injuries in these patients and might more aggressive transfusion strategy improve neurologic outcomes at 12 months?

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Casey Albin, MD @caseyalbin.bsky.social · 10/12/2024

1/ Anemia happens frequently in our aSAH patients. These patients are at risk for delayed cerebral ischemia and other neurologic insults It would seem having adequate oxygen to the brain tissue would be a good thing to prevent such injury. But how much hgb is adequate? A #skytorial on SAHARA

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Andy Webb @ajwpharm.bsky.social · 08/12/2024

Just how early can ketamine be given for SE? In this super interesting report, an EMS group in FL administered IV/IO/IM/IN KET to patients who failed adequate midaz doses. In 56 of 57 (98.2%) of adult cases, SE ceased after KET @ericrosenthalmd.bsky.social pubmed.ncbi.nlm.nih.gov/39642307/

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Stacey L. Clardy @staceylclardy.bsky.social · 29/11/2024

🧠🎙️ Neurology Podcast: Drs. Halley Alexander & Vineet Punia discuss factors influencing the decision to continue or discontinue anti-seizure meds at discharge for patients with acute symptomatic #seizures. Listen now: bit.ly/4fNAKro Article: bit.ly/3B2kZxF #Medsky #Neurosky

bit.ly

Understanding Acute Symptomatic Seizures

Dr. Halley Alexander talks with Dr. Vineet Punia about factors influencing the decision to continue or discontinue anti-seizure medications at discharge for patients hospitalized with acute symptomati...

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Casey Albin, MD @caseyalbin.bsky.social · 29/11/2024

🚨ATTN!!! This is a critical pearl. See it happen ~once a year #neurocrit @ericclawsonmd.bsky.social

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Reposted by Casey Albin, MD

Journal of Clinical Neuroscience @jo-cn.bsky.social · 27/11/2024

/ A 52 year old presents to ED with 1 wk of right periorbital headache & 1 day of diplopia. On exam she has a 4th nerve palsy and no other findings. MRI shown (credit: tinyurl.com/2rezwj69) JoCN #Skytorial on Tolosa-Hunt Syndrome featuring a pub by Ahmed et al.

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Casey Albin, MD @caseyalbin.bsky.social · 27/11/2024

Need to pin to my desktop. Love this!

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Maximilian Friedrich, vertigologist @vertigologist.bsky.social · 18/11/2024

Have you ever felt like you're in a surreal world where sizes and scales are all warped? No, it's not a fantasy—it's a real medical condition! Come dive with me into this mind-bending phenomenon called Alice in Wonderland Syndrome (AIWS): onlinelibrary.wiley.com/doi/abs/10.1...

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Kirk Lester @kirkmed.bsky.social · 25/11/2024

Cortical ribboning of the Northern Lights #neurosky #epilepsy

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Reposted by Casey Albin, MD

josh farkas 💊 @pulmcrit.bsky.social · 25/11/2024

Skytorial: can you crack the case? A middle-aged healthy patient undergoes colonoscopy under propofol sedation. Colonoscopy is unremarkable. Post-procedure, the patient doesn't wake up and has rhythmic movements involving the legs as shown here. Labs are normal. What might be going on?

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Casey Albin, MD @caseyalbin.bsky.social · 26/11/2024

Already making your list and checking it twice?? (Of what to listen to on your Thanksgiving travel… obvi) @StaceyLClardy & I chat about what makes a tweetorial widely shared (Here’s to hoping someone will do a validation study in this platform 😂) open.spotify.com/episode/6XV3...

open.spotify.com

Features of Educational Social Media Posts

Neurology Podcast · Episode

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Casey Albin, MD @caseyalbin.bsky.social · 25/11/2024

Hi there thank you! We are definitely figuring out how we can reach all our audience for neuro content, including posting here!

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Micah Etter, MD @mettermd.bsky.social · 24/11/2024

new all-time banger just dropped🪐👽👍 “The practice of neurosurgery on Saturn is almost identical to the one practiced on Earth.” oh is it??

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Andy Webb @ajwpharm.bsky.social · 22/11/2024

Dr. Daniel's takeaway: Argatroban and eptifibatide, when used as adjunctive therapies to IV thrombolytics, did not reduce disability and may be associated with harm. #NCSPharmJC

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