We are about halfway through the neurology pre-clerkship block. Suffice it to say that despite great teaching and even a half decent textbook, I need all the help with the topic I can get.
After week 1 of the block, I was feeling down and out about my neurology understanding…or more accurately, my lack thereof. I was drowning in internal capsules and stroke syndromes. Seriously, all I could think about was how grey the brain is. I decided to log into twitter and see if I could find a way to inject a bit of colour into the topic. As per Steve Johnson’s eloquent exploration (in this video) of the phenomenon that “chance favours the connected mind“, chance would have it that this post was at the top of my feed.
Given previous adventures with FOAM to supplement curricular learning, I expected to find some good neurology related resources. I just didn’t recognize how good or how perfectly timed some of them would appear.
This post is meant to be the culmination of resources that I have found helpful in a quest to learn a bit of medical student relevant neurology. It started with Andy Neill’s wonderful neuronatomy videos and took off from there. Though by no means 100% complete, it is a good list to get medical students with limited neuro knowledge started. We are only halfway through our neuro block (and as a result halfway through the topics to cover) but I want to post now to get the list out to peers who are studying away. This will be Part 1 of 2, with the second half coming later in the term. If you have resources that you’d like to see added to the list or new topics to incorporate just let me know! I’ve tried to highlight when applicable or interesting, how I came across each resource.
A shout out to the neurology team at Queen’s who provided us with the links to many of these online resources. This was my first experience with a formal curriculum embracing FOAM, though I think they did so unknowingly.
Andy Neill –Applied Anatomy Videos
- Vasculature: Vertebral artery, Cerebral venous sinuses, Anterior and middle cerebral arteries, Posterior cerebral artery
- CSF: Circulation
- Spinal Cord: Anterior Cord Syndrome, Central Cord Syndrome, Brown-seqard
- Cranial Nerves: III, IV and VI nerve palsies, Root Atlas
- Internal capsule
- SMACC 2013 talk on Neuroanatomy
The Pixelated Brain– a free series of self-study tutorials to assist medical students with neuranatomy, neuroscience and clinical neurology. Not the prettiest site but a comprehensive online curriculum.
Medical Neuronatomy Survival Guide for 1st year Medical Students– again, not the prettiest website, but supplies information in an easy to find and straightforward way.
Pathway Quizzes in Neuroanatomy– a series of quizzes on dreaded pathways
- UBC Neuroanatomy – nicely outlines the stroke syndromes associated with different arteries
- Andy Neill’s vasculature video’s- Vertebral artery, Cerebral venous sinuses, Anterior and middle cerebral arteries, Posterior cerebral artery
- Emergsource Factoid: Stroke Syndromes– a very direct (and maybe not thorough enough for the purposes of medical student learning) review of the various stroke syndromes
- LITFL ridiculous concept map on ischemic stroke
- UMEM Pearls– mimics of stroke syndromes
I became a bit overwhelmed by the FOAM literature on this topic. In class we learned that tPA, when given appropriately, is good. We learned that it saves lives, and in the right circumstances, is definitely the way to go. We didn’t learn about existing controversies that surround its use, even when administered “by the books”. This was the first time that FOAM content directly contradicted, not supplemented, what I was being taught in the classroom. It is a strange and slightly disorienting feeling. I’m not in the position to have an opinion one way or the other but have enjoyed reading about the debate. I know this won’t be last time that traditional teaching and my extracurricular FOAM learning come to a head so any tips for how to deal with this ‘conflict’ are very welcomed.
- LITFL extensive review of stroke treatment- this is an older post from 2008, so the evidence isn’t totally up to date but provides a good overview of important considerations
- PV Cards from ALIEM– provide quick tips about grading stroke severity and contraindications to thrombolysis
- SGEM podcasts on Clopidogrel for secondary prevention and outcomes associated with thrombolysis
- Andy Neill’s focus on lytics in stroke
- EM Lit of Note– review of the third international stroke trial (IST-3)
- LITFL Schrodinger’s Fence– this is mostly beyond the scope of our course but nicely outlines the debate on lytics in acute stroke
We learned the basics of MS in a lecture format, then had an epidemiology session focused on reviewing the original evidence on the Liberation Treatment facilitated by Dr. Murray. The articles we reviewed were Zamboni’s 2009 originals here and here. This was more of a “how not to do research” session.
We were also encouraged to take a look at the Canadian CCSVI Systematic Review Group website which commits to frequently and fairly summarizing the evidence on CCSVI trials happening around the world. This is a great resource to find the most up to date evidence.
More than learning extensively about MS through FOAM, my online experience highlighted what a serious responsibility we have to be honest in all parts of academic life and to be skeptical of all that we read regardless of the journal or blog it is published in. It also demonstrated how social media is impacting how physicians are communicating and how patients are accessing information. It showcased the hype that can be propagated by these new ways that we are connecting. For more information on this read the “CCSVI Story in Canada” article.
The main resource that has been helpful for better understanding movement disorders is good old fashioned YouTube. Search just about any movement related disorder and you can get a video demonstrating the signs and symptoms . Instead of reading that chorea “is brief, semi-directed, irregular, unpredictable movements that are not repetitive or rhythmic” why not watch the video.
Do this for any movement related disorder!
Dizziness and Vertigo
We haven’t finished with dizziness and vertigo yet but when this neuro related tweet came across my feed, I couldn’t help but take a look…the link sent me to the EM Basic Review on Dizziness. The podcast is great, the show notes are awesome and it is a nice approach to have in mind.
Other good resources are:
- The Tulane University dizziness and vertigo notes and cases
- American Association of Neurology curricular component on dizziness is especially nice because has quite a few associated practice questions.
- EP monthly’s “simplified approach to vertigo” provides some pearls about what not to miss
To sum up
- There are awesome online resources available to medical students.
- Andy Neill is a neuroanatomy teaching rockstar.
- The CCSVI story and the debate on tPA highlight interesting lessons about social media in medicine and the conflict between classroom learning and FOAM learning.
- It is helpful to visualize movement disorder symptoms, not just read about them.
- EM Basic is a helpful resource to develop an approach to common conditions
- “Chance favours the connected mind”
After all this effort to inject colour, I was disappointed to discover the the brain is still grey. That was until Chris Hadfield, commander of the International Space Station, posted this picture from orbit. It is a Brazilian outcrop that he thought looked like a brain. So, maybe I got it wrong and the brain is colourful after all….at least that’s what I’m going with.
Stay tuned for Part 2 that will come later in the term. It will include resources for: headache, seizures, neuropathies, myopathies, NMJ disorders etc. As always, if you liked this post please email, tweet or facebook away to your friends and colleagues. Comment below if you have some favourite neurology resources that didn’t make it on this list. For more information on other great social media neurology resources see the Neurology Webicina Curation or my previous post, “Blogs to Follow as a Medical Student by Specialty”.
Thanks to Amanda Murdoch, my classmate and comrade in tracking down helpful neurology resources, for peer-reviewing this post.