Thread by @RyanChristieMD

Wetread Case 31

Hx: altered mental status, weakness

Venturing into the Neuro realm 😮 CT pending 🤔

Feel free to answer with professionally appropriate gif responses only. No spoilers. wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #neurorad

CT finally complete

Does this help? Could you have made the diagnosis on the X-ray?

Hint: it may be long standing 😁

#WetreadCow #FOAMrad #FOAMed #radres #errad #neurorad

Answer: Dyke-Davidoff-Masson Syndrome (DDMS)

Early infection/infarction/insult to one of the cerebral hemispheres -> hemi-cerebral atrophy + homolateral hypertrophy of the skull and sinuses (to fill the space)

CT shows large area of encephalomalacia of the R MCA distribution + R calvarial thickening and hyperpneumatization of the frontal sinuses

Bony findings are apparent on the X-ray, just a little more difficult to appreciate (in fact originally described on plain films I believe)

Clinically patients are young presenting with hemiparesis (contralateral of course), seizures and intellectual disability

Did I miss anything @RyanBPetersonMD or @JudyGadde?

#FOAMrad #FOAMed #radres #errad #neurorad