iiinova — where your digital self keeps evolving

Reposted by Micah Etter, MD

Josh Trebach, MD @jtrebach.bsky.social · 22/09/2026

don’t make fun of neurologists until you walk a myelin their shoes

Reposted by Micah Etter, MD

Owen Dennis: Infinity Train/Among Us Show creator @owendennis.com · 14/09/2026

If you're a doctor and you've already clocked what my ailment is after like 2 symptoms, could you let me talk for another minute and then be like "Hmm, it sounds like it's probably X" so I can feel like it's the two of us have a discussion and not that I'm just an annoying question on a pop quiz?

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Reposted by Micah Etter, MD

Diana Cejas, MD, MPH @dianacejasmd.bsky.social · 12/07/2026

It's me & my scar 1 day out of the hospital, 1 week after my stroke, 1 month after my cancer diagnosis And it's me & my scar (& the sun) 14 years & 1 day out of the hospital, 14 years & 1 week after my stroke, 14 years & 1 month after my cancer diagnosis I am still here.

A Black woman (Diana) wearing tortoiseshell glasses and pink robe with little pink flowers on the collar smiles for a bathroom selfie. There are bandages covering the right side of her neck. Her smile is droopy because she recently had a stroke.

The same Black woman (Diana) smiles for a selfie 14 years after the first photo. She has curly braids and wears gold hoop earrings and a green shirt. The late afternoon sun pours through the window and covers the right side of her face and the scar on her neck.

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Reposted by Micah Etter, MD

Ali Christy, MD, PhD @oligoclonalband.medsky.social · 06/06/2026

Coming up! The first GaMER (Games in Medical Education) Conference, free and online, July 17th. A panel of amazing speakers, plus hosts @empiricgame.bsky.social & yours truly. Learn about the creation & study of educational games, make connections and share your work!

Speakers:
Zach London
Scott Crabtree
Mikaela Stiver
Teresa Chan
Jane Newman
Sarah Edwards

Bring info on your games and research in progress to discuss in breakout sessions!

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Reposted by Micah Etter, MD

NEJM.org @nejm.org · 18/03/2026

Among patients with atrial fibrillation at high risk for stroke and bleeding, left atrial appendage closure was not noninferior to medical therapy in reducing the risk of stroke, embolism, major bleeding, or death at 3 years. Full CLOSURE-AF trial results: nej.md/3NFE1Ak #MedSky #CardioSky

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Reposted by Micah Etter, MD

josh farkas 💊 @pulmcrit.bsky.social · 16/03/2026

Fresh blog: Six reasons to stop relying on the NPi (neurological pupil index) 👁️ NPi is based on a secret, proprietary formula used by one company 👁️ The neuroICU field was somehow convinced that we're too stupid to understand pupillometry tracings, so we need the NPi...(#1/2) #EMIMCC

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Reposted by Micah Etter, MD

Pediatric Neurology @pedneurojournal.bsky.social · 26/12/2025

What are the perceptions of clinicians referring to a novel pediatric #neuropalliative clinic? In the latest issue of #pedneuro, Lin et al explores these perceptions. Read here: buff.ly/v2nBte7

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Reposted by Micah Etter, MD

JAMA @jama.com · 26/12/2025

Emergency Medicaid accounts for less than 1% of total #Medicaid spending, even in states with large undocumented populations. ja.ma/3Yx9hDD

Map of the USA illustrating 'Emergency Medicaid Spending for Undocumented Immigrants in the US.' States are shaded in colors ranging from light green (1%) to dark blue (2%), representing the emergency Medicaid share of Medicaid spending. JAMA, published online October 9, 2025.

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Reposted by Micah Etter, MD

brandon-beaber.bsky.social @brandon-beaber.bsky.social · 26/12/2025

Brainstem lesions in MS are also perivenular, often appearing radially in a "sunray" pattern. Authors include Dr. Gavin Giovannoni and Dr. Dr. Klaus Schmierer pubmed.ncbi.nlm.nih.gov/41447908/

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Reposted by Micah Etter, MD

JAMA @jama.com · 27/12/2025

Valacyclovir was associated with greater cognitive decline and did not improve disease markers in patients with symptomatic #AlzheimerDisease and HSV seropositivity. ja.ma/4qydeE1

JAMA infographic: study on valacyclovir for Alzheimer's. Question: Can valacyclovir provide benefit? Conclusion: Not efficacious. Population: 66 women, 54 men, mean age 71.4. Intervention: 120 patients randomized to valacyclovir or placebo. Findings: Valacyclovir worsened cognition vs. placebo.

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Reposted by Micah Etter, MD

Richard Choi, DO, FNCS @rkchoi.bsky.social · 23/12/2025

1/ 👋 there #neurotwitter #neurosky #neurocritcare, and Happy Holidays if you celebrate! As part of my @neurocritcarej #SoMeAmbassador role, today we will be breaking down the following article: link.springer.com/ar... about consent in research involving #DoC

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Micah Etter, MD @mettermd.bsky.social · 22/12/2025

HEY EVERYBODY! i'm back! did you miss me?🙃 i was so busy co-directing the neuro block @UAZMedTucson for 1st year med students that I haven't been around as much... but it gave me time to make LOTS of fun stuff! i'll be gradually releasing, but let's start with...**drumroll**

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Reposted by Micah Etter, MD

Bryan Carmody @jbcarmody.bsky.social · 11/09/2025

On September 24, ERAS will open to programs. Which means applicants have only 2 weeks left to decide which programs to signal. And if you want to know how to allocate your signals in the most effective manner possible, I’ve got something for you: thesheriffofsodium.com/2025/09/10/t...

thesheriffofsodium.com

The Applicant’s Guide to Strategic Preference Signaling

Whenever I discuss preference signaling on social media, one of the first replies is always “Wait – what’s that?” In the olden days, when an applicant was interested in a particular residency…

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Reposted by Micah Etter, 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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Micah Etter, MD @mettermd.bsky.social · 01/09/2025

🚨NEW RELEASE🚨 🔍Daily neurology connections, anyone? neuroconnections.me has launched with a free, fun micro-learning puzzle game every day! Still the initial release so let me know if you spot any bugs.🐛 Play and learn here: neuroconnections.me #Neurology #MedEd

neuroconnections.me

🧠 NeuroConnections

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Micah Etter, MD @mettermd.bsky.social · 26/08/2025

🚨New thing release announcement! 🚨 StrokeBot.me is a free stroke code simulator for trainees! Practice workflows, interventions, disposition calls, and more! This is just the initial release so bugs are expected and updates ongoing! Enjoy! #Neurology #MedEd

strokebot.me

StrokeBot.me - Acute Stroke Simulator

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Reposted by Micah Etter, MD

Eric Topol @erictopol.bsky.social · 10/08/2025

Could a metal ion supplement that cost pennies per day protect from Alzheimer's disease? erictopol.substack.com/p/lithium-an...

lithium ion trapped by beta-amyloid and the way to get around it

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Reposted by Micah Etter, MD

Richard Choi, DO, FNCS @rkchoi.bsky.social · 06/08/2025

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!

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Reposted by Micah Etter, MD

NEJM.org @nejm.org · 24/07/2025

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

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.

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Reposted by Micah Etter, MD

Anthony Lau, PharmD BCPS @alaurx.bsky.social · 14/07/2025

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...

link.springer.com

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

Canadian Journal of Emergency Medicine -

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Reposted by Micah Etter, MD

josh farkas 💊 @pulmcrit.bsky.social · 06/07/2025

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

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Reposted by Micah Etter, MD

Saskia Middeldorp @middeldorps.bsky.social · 22/06/2025

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

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Reposted by Micah Etter, MD

Braydon Dymm, MD @befast.bsky.social · 15/06/2025

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.

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."

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Reposted by Micah Etter, MD

JAMA @jama.com · 22/06/2025

Herpes zoster vaccination eligibility reduced the probability of new dementia diagnoses, suggesting its potential preventive effect. ja.ma/4lagSB6

Herpes Zoster Vaccination and Dementia Occurrence

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Reposted by Micah Etter, MD

Pediatric Neurology @pedneurojournal.bsky.social · 22/06/2025

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

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Reposted by Micah Etter, MD

josh farkas 💊 @pulmcrit.bsky.social · 13/06/2025

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

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Micah Etter, MD @mettermd.bsky.social · 12/06/2025

"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"🫘

alz-journals.onlinelibrary.wiley.com

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.....

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Micah Etter, MD @mettermd.bsky.social · 29/05/2025

🚨 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

tinyurl.com

ICH Calculator One Stop Shop

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Reposted by Micah Etter, MD

CORE IM @coreimpodcast.bsky.social · 29/05/2025

#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...

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Reposted by Micah Etter, MD

Ali Christy, MD, PhD @oligoclonalband.medsky.social · 26/05/2025

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 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.

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Reposted by Micah Etter, MD

NEJM.org @nejm.org · 26/05/2025

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

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.

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Reposted by Micah Etter, MD

josh farkas 💊 @pulmcrit.bsky.social · 16/05/2025

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

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NEJM.org @nejm.org · 15/05/2025

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

nej.md

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.

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Reposted by Micah Etter, MD

Richard Choi, DO, FNCS @rkchoi.bsky.social · 14/05/2025

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

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Reposted by Micah Etter, MD

Science Vs @sciencevs.bsky.social · 08/05/2025

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...

open.spotify.com

Is There Really a Plastic Spoon in Our Brains?

Science Vs · Episode

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Reposted by Micah Etter, MD

Dr. Glaucomflecken @glaucomflecken.bsky.social · 11/05/2025

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

youtube.com

The Dangers of Raw Milk

YouTube video by Dr. Glaucomflecken

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Reposted by Micah Etter, MD

Jamee Walters, MD (she/her) @jameew.bsky.social · 05/05/2025

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.

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Reposted by Micah Etter, MD

Eric Topol @erictopol.bsky.social · 04/05/2025

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

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Reposted by Micah Etter, MD

American Brain Foundation @abfbrain.bsky.social · 21/04/2025

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

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.

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Reposted by Micah Etter, MD

Joel Topf @kidneyboy.bsky.social · 20/04/2025

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:

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.

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Reposted by Micah Etter, MD

Screaming Pectoriloquy @caulimovirus.bsky.social · 23/08/2024

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

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Reposted by Micah Etter, MD

NEJM.org @nejm.org · 20/04/2025

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

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.

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Reposted by Micah Etter, MD

Richard Choi, DO, FNCS @rkchoi.bsky.social · 16/04/2025

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!

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