Andrew Micieli

🧵Stroke Tweetorials👇🧠💉 by @MicieliA_MD Bookmark them for teaching📚. #neurotwitter #stroke #neurology #MedEd

Neurology is so cool: A 61 year old man comes in for another opinion on his diagnosis of ALS Several years of progressive upper limb weakness Exam: upper limb fasciculations, brisk lower limb reflexes One look at the C-spine MR and you know it’s not ALS. What’s going on?

🧠 PFO Closure in Ischemic Stroke & TIA Patients ≥60y 🔗 doi.org/10.1177/239698… 📌 Single-center cohort, n=239 👴 120 patients ≥60y ⏱ 3.1y mean follow-up 🎯 Recurrent stroke rates ▪️PFO closure (≥60y): 6.1% (3/49) ▪️No closure (≥60y): 25.4% (18/71) 📉 aHR = 0.11 (95% CI:…

Introducing Circle of Willis - the board game! The first board game that makes vascular anatomy feel like an epic adventure instead of memorization. ✨ Cooperative gameplay 📷 Gorgeous neuroanatomy art ✨ Sold at cost (education > profit) Learn more: dymm.md

Estimating the clinical penumbra🌒 in acute #stroke. Check out this #ESCAPE-NA1 sub-analysis by @UPensato @StrokeJournal 👀🚨 #neurorad #neuroIR @MDStebnerAl @mayank_G0 @mihill68 @DCNSNeuro ⏩j-stroke.org/journal/view.p…

Cortical vein thrombosis is a very challenging diagnosis to make. Imaging findings = hyperdense cortical vein & cashew nut sign (juxta-cortical hemorrhage) on CT. MRI with SWI is the gold standard (below). Make sure to look carefully at all cuts including topmost! #stroke #CVT

The Canadian Outcome Scale for Minor Stroke (COSMOS): a much-needed, novel 7-point scale to assess more Individualized outcomes in patients with minor stroke (mRS is not sufficient). @StrokeAHA_ASA Kudos to @mayank_G0 @draravindganesh Salome and team. ahajournals.org/doi/10.1161/ST…

Hot off the press, carotid revascularization may be superior to medical treatment in patients with symptomatic carotid artery webs. Excited to start the multicenter SPIDER-WEB study which will provide more insight on this issue. #stroke #annalsofneurology onlinelibrary.wiley.com/doi/10.1002/an…

📚🧠5 Essential Neurology Books (Residency basics) 1. Clinical Neurology & Neuroanatomy @AaronLBerkowitz 2. How to think like a neurologist @emeltzermd 3. The Acute Neurology Survival Guide @caseyalbin 4. The Code Stroke Handbook @MicieliA_MD 5. Brainspotting @ajlees…

NEW PAPER is out! We measured plasma p-tau217 and Aβ42/40 in 509 patients with the cognitive concerns. Worth a read if you're thinking of using blood-based biomarkers in the outpatient clinic. doi.org/10.1002/alz.70… @PiuraYoav1 @MayoClinic @MayoClinicNeuro @mayocliniclabs

Our meta-analysis comparing intracranial hemorrhage risks w/ ASA vs apix, now online @ Stroke. Contrary to common perceptions, we found no evidence in the ischemic stroke prevention setting that apix confers higher intracranial bleeding risk vs ASA. ahajournals.org/doi/10.1161/ST…

Every 10 mg/dL ⬇️ in LDL for patients with ICAD stroke has 9% ⬇️ rates of recurrent stroke or MI. this theoretical framework suggests that PCSK9i can help achieve this. We need PCSK-9i trials in ICAD @JimSiegler @TareqKass @GhannamMalik @ChaturvediNeuro neurology.org/doi/10.1212/WN…

Predicting Alzheimer's in people who are cognitively unimpaired in middle-age via blood tests p-tau217 did well (best single biomarker), its ratio with Aβ42 had highest performance for detecting PET + amyloid new publication today thelancet.com/journals/ebiom…

What if I told you it is possible to increase 6⃣ times the detection of cardioaortic thrombi in stroke patients with a simple tweak to your current workflow? 🤯🤯🤯 We would only need to screen 1⃣4⃣ patients to find 1⃣ thrombus! Curious? Read on! DAYLIGHT Trial…

Presented at #ESOC2025: Among 550 patients with stroke due to large-vessel occlusion who had presented within 4.5 hours after onset, 90-day functional outcomes were better with intravenous tenecteplase before thrombectomy than with thrombectomy alone. Read the full BRIDGE-TNK…

New ESCAPE-MeVO data show collateral status on CTA & time since symptom onset-not occlusion site or vessel size -was linked to 90-day outcome in MeVO stroke. Only collaterals and time predicted EVT benefit. A step toward better selection for reperfusion. #ESOC2025 #VoiceOfStroke

Great article on 3D maps of the LSA territory stroke. First-order (especially when multiple) LSA territory stroke should raise suspicion of ICAD! neurology.org/doi/10.1212/WN…

I was thrilled to give this talk on an important rare CNS inflammatory condition I see relatively frequently in my practice at @UnityHealthTO @SMHNeurology - neurosarcoidosis. A true clinical chameleon, it demands vigilance, early recognition, & collaboration across specialties.

One of my favourite topics to discuss with trainees. Overprescribing of statins in stroke patients and who really needs it and benefits. ahajournals.org/doi/full/10.11…

🚨 Cherry picking of patients can be a major problem in acute stroke trials. @mayank_G0 and I discuss factors contributing to cherry picking (such as the What's In It For Us [WIIFU] problem) + how we might measure and mitigate it: ahajournals.org/doi/10.1161/ST… @DCNSNeuro @StrokeAHA_ASA

Our ANNEXa-I biomarker substudy results were just published in @StrokeAHA_ASA and provide additional insights into the mechanism of action of andexanet alfa (AA) in patients with FXaI-associated ICH. ahajournals.org/doi/10.1161/ST… 🧵 1/3