Discover and read the best of Twitter Threads about #Neurosurgery
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
Let this #tweetorial on PPF #anatomy help you out
#meded #medtwitter #FOAMed #FOAMrad #neurosurgery #neurology #neurorad #neurotwitter #radres
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.
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
Differential Diagnosis for cortically based masses
P-DOG 🐶
1️⃣Pleomorphic Xanthoastrocytoma (PXA)
2️⃣Dysembryoplastic neuroepithelial tumor (DNET)
3️⃣Oligodendroglioma
4️⃣Ganglioglioma
#Neurology #neurosurgery #peds #radres #neurotwitter @The_ASPNR @TheASNR #MedTwitter
P-DOG 🐶
1️⃣Pleomorphic Xanthoastrocytoma (PXA)
2️⃣Dysembryoplastic neuroepithelial tumor (DNET)
3️⃣Oligodendroglioma
4️⃣Ganglioglioma
#Neurology #neurosurgery #peds #radres #neurotwitter @The_ASPNR @TheASNR #MedTwitter
1️⃣PXA
Originate in the subpial astrocytes typically in children and young adults often with a seizure history
Temporal lobe is most common
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
▶️Classically appear as a cortically based mass with cyst and enhancing nodule and overlying DURAL TAIL or enhancing leptomeninges
▶️Calcifications are RARE
1/Remembering spinal fracture classifications is back breaking work!
A #tweetorial to help your remember the scoring system for thoracic & lumbar fractures—“TLICS” to the cool kids!
#medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
A #tweetorial to help your remember the scoring system for thoracic & lumbar fractures—“TLICS” to the cool kids!
#medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
2/TLICS scores a fx on (1) morphology & (2) posterior ligamentous complex injury. Let's start w/morphology. TLICS scores severity like the steps to make & eat a pizza:
Mild compression (kneading), strong compression (rolling), rotation (tossing), & distraction (tearing in)
Mild compression (kneading), strong compression (rolling), rotation (tossing), & distraction (tearing in)
3/At the most mild, w/only mild axial loading, you get the simplest fx, a compression fx—like a simple long bone fx--worth 1 pt.
This is like when you just start to kneading the dough. There's pressure, but not as much as with a rolling pin!
This is like when you just start to kneading the dough. There's pressure, but not as much as with a rolling pin!
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
#ent #Neurosurgery #Neurology #medtwitter #MedEd @The_ASSR #NeuroTwitter
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)
▶️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)
Imaging:
▶️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
▶️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
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
#Ophthalmology #neurology #neurosurgery #neurotwitter #MedEd @TheASNR #MedTwitter
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
▶️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
1️⃣Encephalopathy
2️⃣Branch retinal artery occlusions
3️⃣Hearing loss
💡Though most patients do not present with the complete triad (it may develop over years)
Classic triad
1️⃣Encephalopathy
2️⃣Branch retinal artery occlusions
3️⃣Hearing loss
💡Though most patients do not present with the complete triad (it may develop over years)
1/Understanding cervical radiculopathy is a pain in the neck! But knowing the distributions can help your search
A #tweetorial to help you remember cervical radicular pain distributions
#medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #meded #spine #Neurosurgery
A #tweetorial to help you remember cervical radicular pain distributions
#medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #meded #spine #Neurosurgery
2/First, a rule of thumb—or rather a rule of elbow! You have 10 fingers. If you divide that in half, you get 5.
If you divide your arm in half, that's at the elbow, you'll also get 5--C5 that is! C5 radiates to the elbow. So if it radiates below this, it's > C5 & above is < C5
If you divide your arm in half, that's at the elbow, you'll also get 5--C5 that is! C5 radiates to the elbow. So if it radiates below this, it's > C5 & above is < C5
3/So let’s start with C2. C2 predominantly radiates along the dorsal aspect of the scalp, as it supplies the greater occipital nerve. I remember this bc the number 2 has a swan like neck that mimics the contour of the back of the head and its distribution
Tips & tricks of DWI to help narrow the differential
Ddx:
Stroke
Abscess
Hypercellular tumor
Hematoma
Epidermoid cyst
Encephalitis
Seizure
Demyelination
Toxic/metabolic disorders
CJD
Other stuff I’m forgetting
#Neurology #neurosurgery #radres #MedTwitter #MedEd @TheASNR
Ddx:
Stroke
Abscess
Hypercellular tumor
Hematoma
Epidermoid cyst
Encephalitis
Seizure
Demyelination
Toxic/metabolic disorders
CJD
Other stuff I’m forgetting
#Neurology #neurosurgery #radres #MedTwitter #MedEd @TheASNR
Anything that traps fluid can restrict diffusion! Here are some tricks I use to narrow the ddx
1️⃣STROKE
Cytotoxic edema due to trapped intracellular fluid leads to restriction
Look for wedge shaped restriction in a vascular territory
1️⃣STROKE
Cytotoxic edema due to trapped intracellular fluid leads to restriction
Look for wedge shaped restriction in a vascular territory
2️⃣ABSCESS
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)
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)
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
#neurotwitter #ent #peds #Neurology #neurosurgery @ASHNRSociety @The_ASPNR #MedTwitter
Answer: Sclerosing osteomyelitis of Garré
▶️Biopsy showed a reactive and reparative osseous process and bone culture grew oral flora (though cultures are usually negative)
▶️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)
Interesting case in this patient with acute right-sided weakness
#neurorad #neurotwitter #meded #Neurosurgery #Neurology @TheASNR @RSNA #medtwitter
#neurorad #neurotwitter #meded #Neurosurgery #Neurology @TheASNR @RSNA #medtwitter
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?
▶️ What is the cause of the surrounding hypodensity?
Case of emphysematous epiglottitis in an adult
Epiglottitis is an emergency as it can potentially cause airway compromise especially in children who have smaller airways #neurotwitter #ent #peds #Neurosurgery #MedTwitter #MedEd @ASHNRSociety
Epiglottitis is an emergency as it can potentially cause airway compromise especially in children who have smaller airways #neurotwitter #ent #peds #Neurosurgery #MedTwitter #MedEd @ASHNRSociety
▶️In children the diagnosis can be confirmed with upright plain film. CT requires placing the patient supine which may exacerbate inspiratory strider
▶️In adults, the diagnosis may not be suspected clinically so patients may end up with a CT scan as in this case
▶️In adults, the diagnosis may not be suspected clinically so patients may end up with a CT scan as in this case
▶️Bacterial infection typically 2/2 H. Influenza in unvaccinated children
▶️In adults, possible pathogens include Strep, Staph, and H. influ
▶️In adults, possible pathogens include Strep, Staph, and H. influ
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
#NeuroTwitter #neurosurgery #Neurology #peds #futureradres @The_ASPNR #MedEd
▶️Prospectively this mass was thought to be an embryonal tumor w/ multilayered rosettes given the marked diffusion restriction, hemorrhage, and lack of surrounding edema 🧠
Imaging:
▶️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)
▶️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)
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
#NeuroRad #neurosurgery #Neurology @TheASNR #NeuroTwitter #meded #radres
Brain radiation is a risk factor for the development of meningiomas …this patient subsequently developed multiple meningiomas including this large frontal meningioma
The mass was treated and immediate post op CT shows expected post op change with the resection cavity, some hemorrhage, and pneumocephalus
Interesting case of complicated acute bacterial rhinosinusitis in this child with no PMH presenting w/ HA, fever & L sided weakness
#NeuroTwitter #ent #radres #neurosurgery @TheASNR @ASHNRSociety @PhilipRChapman1 #radres #futureradres
#NeuroTwitter #ent #radres #neurosurgery @TheASNR @ASHNRSociety @PhilipRChapman1 #radres #futureradres
CT shows opacification of the frontal and anterior ethmoid sinuses without evidence of cortical dehiscence
💡 In peds, infection can spread through vascular channels w/o destroying the bone
💡 In peds, infection can spread through vascular channels w/o destroying the bone
MR shows abnormal signal filling the sinuses with associated restricted diffusion 2/2 purulent material
Post contrast we see areas of relative hypoenhancement in comparison to the normal mucosa on the contralateral side
Post contrast we see areas of relative hypoenhancement in comparison to the normal mucosa on the contralateral side
1/Do you want a BASIC approach to skullBASE lesions?
My FINAL tweetorial on skullbase lesions—posterior skullbase & overall approach!
This #tweetorial will teach you to diagnose skullbase lesions by answering only TWO simple questions!
#medtwitter #meded #neurosurgery #radres
My FINAL tweetorial on skullbase lesions—posterior skullbase & overall approach!
This #tweetorial will teach you to diagnose skullbase lesions by answering only TWO simple questions!
#medtwitter #meded #neurosurgery #radres
2/Remember, you can think of pathology at the skullbase like bad things that can happen while running. Bad things can get you from below—like falling into a pothole. They can come from within—like a sudden heart attack, or bad things can strike from above, like a lightning bolt
3/Same thing w/the skullbase—bad things can come from below, within, or above. Lesions from below are potholes tripping you up. Lesions from w/in the skullbase are like heart attacks strikning from inside. Lesions from above are the lightning, hitting the skullbase from above
1/Talk about the bases being loaded!
Central skull base has some of the most complicated anatomy & pathology in neuro
Do you know how to approach it?
Here’s a #tweetorial to show you how diagnose lesions at the central skullbase!
#meded #medtwitter #FOAMed #neurosurgery
Central skull base has some of the most complicated anatomy & pathology in neuro
Do you know how to approach it?
Here’s a #tweetorial to show you how diagnose lesions at the central skullbase!
#meded #medtwitter #FOAMed #neurosurgery
2/Think of the skullbase divisions like different countries—each w/their own culture. Each division has lesions that are specific to it—just like countries have food that are specific to them.
I think the central skullbase looks like Italy, hanging down from the ant. skullbase
I think the central skullbase looks like Italy, hanging down from the ant. skullbase
3/Lesions can involve the central skullbase from below, within, or above
Let’s start from below. Nasopharynx is below the central skullbase. Nasopharyngeal carcinomas (NPC) can invade from below
Using our Italy theme, you can remember this bc NPC look like an Italian meatball
Let’s start from below. Nasopharynx is below the central skullbase. Nasopharyngeal carcinomas (NPC) can invade from below
Using our Italy theme, you can remember this bc NPC look like an Italian meatball
1/It’s called the skullBASE but it’s anything but BASIC!
Does the sight of a skullbase lesion strike fear into your heart?
Never fear! Here’s a #tweetorial about a simple approach to these lesions that will change how you look at these cases
#medtwitter #meded #neurosurgery
Does the sight of a skullbase lesion strike fear into your heart?
Never fear! Here’s a #tweetorial about a simple approach to these lesions that will change how you look at these cases
#medtwitter #meded #neurosurgery
2/Everyone fears the skullbase. It is so complex that not even experts can agree on a classification for the anatomy.
But you don’t need to know detailed anatomy to be able to give a differential diagnosis for a skullbase lesion that accurate & almost as importantly—short.
But you don’t need to know detailed anatomy to be able to give a differential diagnosis for a skullbase lesion that accurate & almost as importantly—short.
3/The skullbase is incredibly important. If you think of your brain as master or God of your body, then the skullbase is where the finger of God breathes life into the rest of you. All of the neuronal information from the brain travels through the skullbase to bring you to life
1/Do radiologists sound like they are speaking a different language when they talk about MRI? T1 shortening what? T2 prolongation who?
Here’s a translation w/a #tweetorial introduction to MRI.
#medtwitter #FOAMed #FOAMrad #medstudent #neurorad #radres #ASNR23 #neurosurgery
Here’s a translation w/a #tweetorial introduction to MRI.
#medtwitter #FOAMed #FOAMrad #medstudent #neurorad #radres #ASNR23 #neurosurgery
2/When it comes to bread and butter neuroimaging—MRI is definitely the butter. Butter makes everything taste better and packs a lot of calories. MRI can add so much information to a case
3/In fact, if CT is a looking glass into the brain—MRI is a microscope. It can tell us so much more about the brain and pathology that affects the brain.
So let’s talk about the basic sequences that make up an MRI and what they can show us.
So let’s talk about the basic sequences that make up an MRI and what they can show us.
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
(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 🧵
Predicting tumors is incredibly challenging in the absence of specific features …some learning points on the case in 🧵
Case of a radiation induced pseudoaneurysm in this patient with headache and AMS 🧠
Imaging in thread #Neurosurgery #Neurology #neurotwitter #radres #MedEd #MedTwitter @TheASNR
Imaging in thread #Neurosurgery #Neurology #neurotwitter #radres #MedEd #MedTwitter @TheASNR
▶️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)
▶️CTA confirms an aneurysm of the right anterior inferior cerebellar artery (AICA)
▶️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
▶️Careful search into the history confirms the schwannoma was treated with radiation
What is the most likely diagnosis in this 25 y/o M with headache? 🧠
Answer later tonight #radres #Neurology #Neurosurgery #MedEd #MedTwitter #NeuroTwitter @RSNA
Answer later tonight #radres #Neurology #Neurosurgery #MedEd #MedTwitter #NeuroTwitter @RSNA
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 🧠
Glioblastoma is the most common variety of astrocytoma
The presence of necrosis is the characteristic feature of glioblastoma
Imaging details in thread #Neurosurgery #neurotwitter #radres #MedTwitter #Neurology @TheASNR
The presence of necrosis is the characteristic feature of glioblastoma
Imaging details in thread #Neurosurgery #neurotwitter #radres #MedTwitter #Neurology @TheASNR
Some correlates for high grade astrocytoma include necrosis, marked mass effect, restricted diffusion (often patchy, eccentric or nodular in glioblastoma), elevated CBV, enhancement, and older age
The presence of ependymal spread is another poor prognostic sign (shown below)
The presence of ependymal spread is another poor prognostic sign (shown below)
Important learning point: when dealing with glioblastoma, the neoplasm extent is not defined by the area of enhancement but rather by the entire area of T2/FLAIR abnormality. Microscopic infiltrating tumor clearly extends beyond the areas of enhancement. 🧠
Preoperative approach to sellar region masses, what the surgeon needs to know (at least what I think they need to know)
Additional reporting tips from surgeons are welcomed and encouraged! #Neurosurgery @TheASNR #radres #MedEd #MedTwitter #futureradres #endocrine #Neurology
Additional reporting tips from surgeons are welcomed and encouraged! #Neurosurgery @TheASNR #radres #MedEd #MedTwitter #futureradres #endocrine #Neurology
1️⃣Where is the mass located?
Is it sellar based? suprasellar (S)? clival? Planum sphenoidale (PS)? Tuberculum sellae (arrow)?
▶️Location can change operative approach including but not limited to subfrontal vs transsphenoidal
Is it sellar based? suprasellar (S)? clival? Planum sphenoidale (PS)? Tuberculum sellae (arrow)?
▶️Location can change operative approach including but not limited to subfrontal vs transsphenoidal
2️⃣Where is the normal pituitary gland?
▶️this can be tough when the mass is large but the normal tissue often enhances more avidly than tumor so look for a strip of relatively avid enhancement along the periphery of the mass. Surgeons do not want to remove normal pit tissue
▶️this can be tough when the mass is large but the normal tissue often enhances more avidly than tumor so look for a strip of relatively avid enhancement along the periphery of the mass. Surgeons do not want to remove normal pit tissue
1/I call the skullbase “homebase” bc you can’t make an anatomy homerun without it!
Most know the arteries of the skullbase, but few know the veins. Do you?
Here’s a🧵to help you remember #skullbase venous #anatomy!
#medtwitter #meded #neurorad #radtwitter #neurosurgery #radres
Most know the arteries of the skullbase, but few know the veins. Do you?
Here’s a🧵to help you remember #skullbase venous #anatomy!
#medtwitter #meded #neurorad #radtwitter #neurosurgery #radres
2/When I look at the skullbase veins, I see an angry Santa yelling at me. His eyebrows are raised, his mouth is open, & he has a mustache w/a big beard hanging down.
Each I look at the skullbase, I look for this Santa—bc each part of him is an important venous structure.
Each I look at the skullbase, I look for this Santa—bc each part of him is an important venous structure.
3/So let’s start w/Santa’s eyes. The eyes are actually not a venous structure, but an important landmark—foramen ovale, where the V3 trigeminal nerve exit.
I remember ovale is Santa's eyes bc eyes are OVAL, so his eyes are OVALE
I remember ovale is Santa's eyes bc eyes are OVAL, so his eyes are OVALE
Can you figure out the cause of hemorrhage in this case?
Imaging and case details in thread #Neurosurgery #radres #MedTwitter #Neurology @TheASNR #MedEd #neurotwitter
Imaging and case details in thread #Neurosurgery #radres #MedTwitter #Neurology @TheASNR #MedEd #neurotwitter
Initial MRI shows an expansile enhancing mass in the right parasagittal frontal lobe
The patient underwent craniotomy for tumor debulking. Post operative MRI and CT demonstrate hemorrhage in the right cerebellar hemisphere, far from the operative site. What’s the cause of the hemorrhage? 🤔 🧠
