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Daniel Gewolb, MD Profile picture
@daniel_gewolb
Dec 16, 2022 • 3 tweets • 2 min read • Read on X
78 yr old with encephalopathy and seizure. MRI shows vasogenic edema within the left temporal and occipital white matter with subcortical extension. SWI shows characteristic lobar micro-hemorrhages predominantly in the effected regions.
#Neurology #neuroradiology #radres ImageImageImageImage
Ddx:
PML
Inflammatory amyloid angiopathy
PRES
Amyloid-related imaging abnormalities (ARIA)
Answer: Inflammatory amyloid angiopathy

This can be indistinguishable from amyloid-related imaging abnormalities (ARIA) seen in patients undergoing treatment for Alzheimer’s disease. Therapies include:

bapineuzumab, solanezumab and aducanumab

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More from @daniel_gewolb

Daniel Gewolb, MD Profile picture
Feb 12
⭐️ Venous variants and abnormalities are the most common causes of pulsatile tinnitus

Differential and learning points in 🧵

#ENT #neurosurgery #Neurology #Medicine #MedEd #radres #futureradres @ASHNRSociety Image
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🔷Ddx for venous causes of PT:

Idiopathic intracranial hypertension
Sigmoid plate dehiscence +/- diverticulum
Transverse sinus stenosis (w/ or w/o IIH)
Jugular bulb abnormalities
Dilated emissary veins
Extracranial IJ compression
Prominent occipital sinus
Occipital sinus stenosis
🔷Tinnitus occurs from turbulence within normally located veins and abnormally enlarged or located veins in close proximity to the conductive auditory pathways

🔷Concomitant venous findings may share the same pathophysiologic mechanism and may have additive effects causing PT
Read 23 tweets
Daniel Gewolb, MD Profile picture
Dec 10, 2024
Back from Belize! 🇧🇿

🔷What is the most likely diagnosis in this 25 y/o F w/ a band-like scalp lesion and local alopecia?

#Medicine #radres #futureradres #ENT #Rheum #Neurology #neurosurgery #Ophthalmology #FOAMed Image
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Answer: Linear Scleroderma aka Scleroderma en coup de sabre

🔷Linear scleroderma is a focal form of scleroderma resulting in atrophy and alopecia of the frontal or frontoparietal scalp

🔷Atrophy involves the subjacent skull +/- underlying brain parenchyma (as seen in this case)
🔷Brain parenchymal abnormalities may have calcifications or micro-hemorrhage

🔷Linear scleroderma is associated w/ progressive facial hemiatrophy (Parry-Romberg syndrome) Image
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Read 4 tweets
Daniel Gewolb, MD Profile picture
Nov 27, 2024
⭐️ What is the most likely diagnosis in this asymptomatic patient? What would your recommendation be if any?

#ENT @ASHNRSociety #Medicine #radres #futureradres #Neurology #Neurosurgery #ophthalmology #FOAMed Image
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Answer: Benign-appearing notochordal lesion (formally ecchordosis physaliphora, EP)

💡 If no remote priors for comparison, recommend 6 month follow up which can be extended if unchanged at that time
🔷Pathologic nomenclature was revised from EP to benign notochordal cell tumor (BNCT)

🔷Notochordal remnants are a pathologic spectrum ranging from benign (EP/BNCT), indolent, intermediate, & aggressive chordomas
Read 7 tweets
Daniel Gewolb, MD Profile picture
Nov 24, 2024
⭐️What is the most likely diagnosis in this 40 y/o M presenting w/ 10 days of L neck/throat/ear pain, worsened by neck palpation and head turning?

🔷PMH: None
🔷ESR/CRP: Mildly ⬆️

#Medicine #Neurology #neurosurgery #ENT #radres #futureradres #FOAMed @ASHNRSociety Image
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⭐️ Answer: Transient Perivascular Inflammation of the Carotid Artery (Carotidynia or Fay syndrome)
🔷Pathology: Unknown inflammatory process of the carotid wall

🔷Epidemiology:
▶️Young and middle age adults
▶️No gender predilection
Read 7 tweets
Daniel Gewolb, MD Profile picture
Nov 22, 2024
What is the most likely diagnosis in this 30 y/o M presenting with seizures, fever & headache?

🔷CSF x2:
Worsening neutrophilic pleocytosis despite Abx
Negative infectious studies
No malignancy on cyto/flow
OCBs +

🔷CT CAP: normal
#neurology #medicine #radres @AlbanyMedRadRes Image
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Additional image 👇
#futureradres #Neurosurgery #FOAMed Image
Answer: FUEL “FLAIR-variable unilateral enhancement of the leptomeninges” in MOGAD

🔷MOG antibody-associated disease (MOG-AAD)

Path: MOG-AAD is an autoimmune inflammatory demyelinating disease targeting oligodendrocytes
Read 12 tweets
Daniel Gewolb, MD Profile picture
Nov 19, 2024
⭐️ Classic case: 45 y/o Female presents w/ intermittent R pulsatile tinnitus for 1-2 years, what’s the most likely diagnosis?

#meded #medicine #ENT #Neurology #radres #futureradres #neurosurgery @ASHNRSociety Image
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Answer: Glomus Tympanicum Paraganglioma

🔷PATHOLOGY: Benign tumor arising from glomus bodies along the inferior tympanic nerve (Jacobson nerve)
🔷CLINICAL:
▶️Vascular retrotympanic mass
▶️Pulsatile tinnitus
▶️Female predominance (~3:1)
▶️Generally middle age at diagnosis
Read 8 tweets

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