Discover and read the best of Twitter Threads about #Neurology

Most recents (24)

1/Does PTERYGOPALATINE FOSSA anatomy feel as confusing as its spelling? Does it seem to have as many openings as letters in its name?

Let this #tweetorial on PPF #anatomy help you out

#meded #medtwitter #FOAMed #FOAMrad #neurosurgery #neurology #neurorad #neurotwitter #radres Image
2/The PPF is a crossroads between the skullbase & the extracranial head and neck. There are 4 main regions that meet here. The skullbase itself posteriorly, the nasal cavity medially, the infratemporal fossa laterally, and the orbit anteriorly. Image
3/At its most basic, you can think of the PPF as a room with 4 doors opening to each of these regions: one posteriorly to the skullbase, one medially to the nasal cavity, one laterally to the infratemporal fossa, and one anteriorly to the orbit Image
Read 18 tweets
Differential Diagnosis for cortically based masses


1️⃣Pleomorphic Xanthoastrocytoma (PXA)
2️⃣Dysembryoplastic neuroepithelial tumor (DNET)
#Neurology #neurosurgery #peds #radres #neurotwitter @The_ASPNR @TheASNR #MedTwitter ImageImageImageImage

Originate in the subpial astrocytes typically in children and young adults often with a seizure history

Temporal lobe is most common
Imaging (variable):

▶️Classically appear as a cortically based mass with cyst and enhancing nodule and overlying DURAL TAIL or enhancing leptomeninges

▶️Calcifications are RARE ImageImage
Read 14 tweets
Tuberculous Meningitis in this child w/ fevers and lethargy

💡 COMMUNICATING HYDROCEPHALUS with DEEP INFARCTION is highly suggestive of granulomatous meningitis
#neurology #MedTwitter #neurotwitter @TheASNR #MedEd #futureradres ImageImageImageImage
▶️In children, primary TB infection is commonly associated w/ meningitis

▶️Exudative meningitis of the basal cisterns can obstruct the normal CSF flow resulting in hydrocephalus
▶️Infectious vasculitis or spasm can result in infarction (particularly of the basal ganglia)

▶️Cranial nerve palsy can also be seen due to infectious neuritis
Read 4 tweets
What is the most likely diagnosis in this 30 y/o w/ history of discitis/osteomyelitis presenting w/ fevers, chills, and neck pain? 🧠
#ent #Neurosurgery #Neurology #medtwitter #MedEd @The_ASSR #NeuroTwitter ImageImageImageImage
Answer: Longus Colli Calcific Tendinitis

▶️Etiology: inflammatory reaction in response to deposition of calcium hydroxyapatite crystals (just like in the rotator cuff)

▶️This case is a bit tricky as the history is somewhat misleading (though it often is in radiology)

▶️Sagittal STIR shows marked retropharyngeal/prevertebral edema (yellow arrow) and focal hypointensity from the hydroxyapatite crystals (green arrow)

▶️Axial T2 again shows the marked edema ImageImage
Read 9 tweets
Interesting case, what is the most likely diagnosis in this 25 y/o F w/ 1 year history of migraine headaches, left hand numbness, and b/l retinal artery occlusions? 🧠 👁️
#Ophthalmology #neurology #neurosurgery #neurotwitter #MedEd @TheASNR #MedTwitter ImageImageImageImage
Answer: Susac syndrome 🧠

▶️Susac syndrome is a microangiopathy (likely autoimmune affecting the precapillary arterioles) with a strong female predilection, typically occurring in women age 20-40
Clinical presentation:

Classic triad
2️⃣Branch retinal artery occlusions
3️⃣Hearing loss

💡Though most patients do not present with the complete triad (it may develop over years)
Read 7 tweets
In this thread, we will have fun talking about how a ketogenic diet makes for a healthy brain. And sharing just a small portion of the research that proves I am not making this up! Are you ready? 🧠🧵(1/14)
The ketogenic diet (KD) has been linked to significant neuroprotective effects, with Beta-hydroxybutyrate acid (BHBA) playing a key role in preventing neurodegenerative disorders. I kid you not. Ketogenic diets are no joke when it comes to having a kick-ass brain! (2/14)
Microglial cells play a crucial role in neurodegenerative disorders, but BHBA from the ketogenic diet can help. It promotes an anti-inflammatory microglial phenotype, reduces migration, and modulates cytokine levels. The implications for neuroprotection are off the charts! (3/14)
Read 14 tweets
Tips & tricks of DWI to help narrow the differential

Hypercellular tumor
Epidermoid cyst
Toxic/metabolic disorders
Other stuff I’m forgetting
#Neurology #neurosurgery #radres #MedTwitter #MedEd @TheASNR ImageImageImageImage
Anything that traps fluid can restrict diffusion! Here are some tricks I use to narrow the ddx

Cytotoxic edema due to trapped intracellular fluid leads to restriction

Look for wedge shaped restriction in a vascular territory Image
Trapped purulent material leads to LIGHT BULB BRIGHT restriction

DWI is excellent for differentiating tumor from pyogenic abscess as the abscess will have CENTRAL restriction

Abscess should also have vasogenic EDEMA, ENHANCEMENT, and possible dual rim sign (T2 & SWI) ImageImage
Read 14 tweets
Eyes are the windows into the Brain

Here, I discuss 9 situations where symptoms are related to eyes or vision, but disease pertains to brain or nervous system.
1. Sudden onset painless loss of vision- Optic neuritis (inflammation of optic nerve)- Multiple sclerosis
2. Sudden onset loss of vision on one half (left or right)- called homonymous hemianopia- usually caused by an infarct (clot) of occipital lobe of brain.

3. Inability to see on outer aspects of visual field (temporal visual field loss)- usually caused by pituitary tumor.
4. Drooping of one or both eyelids- called ptosis, usually caused by myasthenia gravis or third cranial nerve palsy.

5. Double vision (diplopia)- caused by 3rd, 4th or 6th cranial nerve palsies; also myasthenia gravis.
#neurotwitter #eyes #Neurology
Read 7 tweets
1/Time is brain! So you don’t have time to struggle w/that stroke alert head CT.
Here’s a #tweetorial to help you with the CT findings in acute stroke.

#medtwitter #FOAMed #FOAMrad #ESOC #medstudent #neurorad #radres #meded #radtwitter #stroke #neurology #neurotwitter Image
2/CT in acute stroke has 2 main purposes—(1) exclude intracranial hemorrhage (a contraindication to thrombolysis) & (2) exclude other pathologies mimicking acute stroke. However, that doesn’t mean you can’t see other findings that can help you diagnosis a stroke. Image
3/Infarct appearance depends on timing. In first 12 hrs, the most common imaging finding is…a normal head CT. However, in some, you see a hyperdense artery or basal ganglia obscuration. Later in the acute period, you see loss of gray white differentiation & sulcal effacement Image
Read 13 tweets
Child with a history of dental caries presents with a firm mass at the angle of the mandible. What is the most likely diagnosis? 🤔 🧠

#neurotwitter #ent #peds #Neurology #neurosurgery @ASHNRSociety @The_ASPNR #MedTwitter ImageImageImageImage
Answer: Sclerosing osteomyelitis of Garré

▶️Biopsy showed a reactive and reparative osseous process and bone culture grew oral flora (though cultures are usually negative)
▶️SOG is thought to be due to a low grade infection possibly 2/2 dental disease. However, there should be no signs of acute infection (suppuration, bony sequestration or draining tracts)
Read 7 tweets
Interesting case in this patient with acute right-sided weakness

#neurorad #neurotwitter #meded #Neurosurgery #Neurology @TheASNR @RSNA #medtwitter ImageImageImageImage
Can you determine the diagnosis off the CT?
▶️Initial non-con CT shows a 3cm hyperdense lobulated extra-axial mass in the expected region of the left MCA bifurcation, consistent with a giant aneurysm. There are associated peripheral calcifications

▶️ What is the cause of the surrounding hypodensity?
Read 10 tweets
Case of diffuse CSF seeding of tumor in this patient w/ WHO grade 4 diffuse hemispheric glioma

#NeuroTwitter #neurosurgery #Neurology #peds #futureradres @The_ASPNR #MedEd ImageImageImageImage
▶️Prospectively this mass was thought to be an embryonal tumor w/ multilayered rosettes given the marked diffusion restriction, hemorrhage, and lack of surrounding edema 🧠

▶️T2 shows a heterogenous slightly hyperintense mass w/ areas of hypointensity

▶️No surrounding edema/infiltrating tumor is seen on T2/FLAIR

▶️Fluid-fluid level is seen suggestive of hemorrhage (arrow) Image
Read 6 tweets
Learning case in this 40 y/o F with history of whole brain radiation as a child for brain tumor treatment
#NeuroRad #neurosurgery #Neurology @TheASNR #NeuroTwitter #meded #radres ImageImageImageImage
Brain radiation is a risk factor for the development of meningiomas …this patient subsequently developed multiple meningiomas including this large frontal meningioma Image
The mass was treated and immediate post op CT shows expected post op change with the resection cavity, some hemorrhage, and pneumocephalus Image
Read 9 tweets
Atypical variants of motor neuron disease.



Does the phenotype matter?

Yes, as prognosis is different in some variants.

1/🧵 Image
a) Spinal-Onset ALS
b) Progressive Muscular Atrophy
c) Progressive Bulbar Palsy/Bulbar-onset ALS
d) Facial onset sensory and motor neuronopathy (FOSMN)
e) Flail-arm syndrome (Vulpian-Bernhardt syndrome): LMN upper limbs and UMN (usually only brisk reflexes in lower limbs)
f) Hirayama disease: monomelic amyotrophy
g) O’Sullivan-McLeod syndrome: slowly progressive distal amyotrophy of the hands and forearms extending over long periods of time
h) Flail-leg syndrome
Read 5 tweets
We were consulted for a 2nd opinion.
30F. D1. Deep dog bite L cheek while tending fields. Multiple others bitten. Dog was killed the same day by villagers. #NeuroTwitter #MedTwitter #IDtwitter #NeuroRad #Neurology Image
D2. Visited PHC.
Prescribed PVRV (Abhayrab) D2, D5, D8, D13. NO RIG given. Image
D16. Fever, uncontrolled vomiting.
D20: admitted. Rx as sepsis.
D22 discharged. No hydro/aerophobia.
D23. Drowsy/unresponsive/taking orally food/water. Readmitted.
NB: Aerophobia is seen in ~50%, Hydrophobia in 10-15% Image
Read 11 tweets
Clinical case! 🧠💭🧵
1/7 A 26-year-old woman from a rural region of Mexico presented in a state of catatonia. At age 21, she begun to exhibit aggressiveness. At age 23, she started having difficulties handling money, she constantly misplaced things. Sometimes she was disoriented
2/7 At age 26, 2 days after delivering her first child, she had a (first) psychotic episode, with incoherent speech, disorganized behavior, aggressiveness, visual & auditory hallucinations. She neglected her newborn, saying repeatedly that the child was not hers.
3/7 Psychotic symptoms were mixed with periods of catatonia. She recieved risperidone 2 mg/day, which worsened the catatonic states. She was referred to our hospital. On admission, risperidone was suspended. We observed immobility, mutism, staring, posturing, waxy flexibility...
Read 8 tweets
1/Time is brain! But what time is it?

If you don’t know the time of stroke onset, are you able to deduce it from imaging?

Here’s a #tweetorial to help you date a #stroke on MR!
#medtwitter #meded #neurotwitter #neurology #neurorad #radres #radtwitter #radiology #FOAMed #FOAMrad
2/In up to 25% of acute stroke patients, the time of last known well is well, not known. Then it’s important to use the stroke’s MR imaging features to help date its timing. Is it hyperacute? Acute? Subacute? Or are the “stroke” symptoms from a seizure from their chronic infarct?
3/Strokes evolve, or grow old, the same way people evolve or grow old. The appearance of stroke on imaging mirrors the life stages of a person—you just have to change days for a stroke into years for a person. So 15 day old stroke has features of a 15 year old person, etc.
Read 22 tweets
It is finally online.

Co-editor @LudyShih and I thank the wonderful authors for an incredible diagnostic approach through phenomenology, as well as poignant related topics.


A 🧵on topics

#NeuroTwitter #MedTwitter
Movement disorders across the world: rare or underdiagnosed?

Drs. @ludyshihmd and @SarahOSheaMD review the epidemiology of movement disorders.

@RoyCLinMD and Dr. Sheng-Han Kuo present their approach to Ataxia.
Dr. @SanjayP30043502 and colleagues review approach to drug-induced movement disorders.

Dr. Stephen and colleagues @MGHNeurology present their approach to Dystonia and additional diagnostic testing.
Read 9 tweets
Avec des vaccins à l'efficacité de plus en plus limitée (50% au mieux face à XBB 1.5 contre plus de 90% sur les premiers variants)…

> face à l'échappement immunitaire, quelle logique de l'obligation vaccinale si d'ici l'été la protection tombe à 25/30% ?
On peut aussi noter le variant BQ.1.1 Cerberus...

À chaque mutation de + en + sélectionnée par la pression immunitaire et vaccinale, le virus mutant résistant est sélectionné et diminue l'efficacité vaccinale car la vitesse d'évolution et complexité du virus va + vite ImageImageImage
De + chaque réinfection ⬆️ les risques de décès, d'hospitalisation, mais aussi de + en + kde séquelles, notamment pulmonaires, troubles cardiovasculaires, hématologiques, diabétiques, gastro-intestinaux, rénaux, de santé mentale, musculo-squelettiques et neurologiques.
Read 14 tweets
An illustration of the importance of pattern recognition in Neurology. At the outset, let me reveal this is a Myopathy. Try to note how this particular one is different from others. 10 years history

As with most myopathies, limb girdle weakness is present
But wait! Foot drop and prominent distal muscle weakness in a muscle disease??
And look at how strong the Quadriceps are! weak proximal and weakness with selective sparing of the quadriceps!
Read 9 tweets
What is the most likely diagnosis in this adolescent with seizure? 🧠

(Sorry I have no CT without)

#neurotwitter #peds #Neurosurgery #Neurology @The_ASPNR @TheASNR #MedTwitter
What is the most likely diagnosis?
Answer: Confirmed supratentorial ependymoma

Predicting tumors is incredibly challenging in the absence of specific features …some learning points on the case in 🧵
Read 8 tweets
Case of a radiation induced pseudoaneurysm in this patient with headache and AMS 🧠

Imaging in thread #Neurosurgery #Neurology #neurotwitter #radres #MedEd #MedTwitter @TheASNR ImageImageImageImage
▶️Initial head CT shows subarachnoid hemorrhage centered in the right cerebellopontine angle cistern

▶️CTA confirms an aneurysm of the right anterior inferior cerebellar artery (AICA) ImageImage
▶️MR displays and ice cream shaped enhancing mass extending through the right internal auditory canal into the cerebellopontine angle cistern, consistent with a vestibular schwannoma #icecream

▶️Careful search into the history confirms the schwannoma was treated with radiation ImageImage
Read 4 tweets
Do you have an undiagnosed patient despite exome sequencing? 🤔

It could be a repeat expansion disorder.

Here are 5 scenarios that should make you think of a repeat expansion disorder in adults. 🧵

#GeneChat #MedTwitter
A 21 y man with slurred speech who is experiencing difficulty with coordination and balance over the last several years. He fatigues easily.

Diagnosis: Friedreich's ataxia
Genetics: GAA repeat expansion in the 1st intron of FXN
Inheritance: Autosomal recessive

A 25 y woman with hot flashes and irregular menses over the last several months (early menopause).

Diagnosis: Fragile X-associated primary ovarian insufficiency (FXPOI)
Genetics: CGG repeat expansion in the 5' UTR of FMR1
Inheritance: X-linked

Read 7 tweets
What is the most likely diagnosis in this 25 y/o M with headache? 🧠

Answer later tonight #radres #Neurology #Neurosurgery #MedEd #MedTwitter #NeuroTwitter @RSNA ImageImageImageImage
Most likely diagnosis?
Answer: confirmed germinoma, all these masses are on the differential for a pineal region mass …perhaps the most helpful clue is the age and gender rather than the imaging 🧠
Read 7 tweets

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