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Daniel Gewolb, MD

@daniel_gewolb

Nov 15

60 y/o F presents w/ several months of confusion, word finding difficulty & gait dysfunction

🔷What is your best guess and differential?

🔷More images in 🧵
#MedEd #radiology #Neurology #radres #neurosurgery #medicine #ENT #Ophthalmology #futureradres

🔷More images 👇

Answer: Glioblastoma on pathology

🔷Imaging: Tumor, high grade glioma vs lymphoma

🔷This case of glioblastoma is not classic and has overlapping features with lymphoma

Read 11 tweets

Daniel Gewolb, MD

@daniel_gewolb

Aug 31

Difficult case, let’s run this together. 70 y/o M w/ Hx of HTN presents with acute confusion, dysarthria and facial droop

Images in 🧵

#Neurology #neurosurgery #MedEd #medicine #radres #ENT #futureradres

🔷First thing we notice is hemorrhage in the left basal ganglia

🔷Classically, hemorrhage in the basal ganglia in an adult with hypertension we think of hypertensive hemorrhage but the morphology does not match here

🔷The hemorrhage is confined to the gray matter so right now we should be thinking stroke with hemorrhagic transformation

🔷However, the mass effect seems disproportionate to the amount of hemorrhage and with relative preservation of the gray white differentiation 🤔

Read 10 tweets

Daniel Gewolb, MD

@daniel_gewolb

Jun 4

What is the most likely diagnosis in this 20 y/o M presenting w/ seizure, weakness, AKI & hypertension?

CT in 🧵

#meded #neurology #neurosurgery #FOAMed #neurorad #ENT @AlbanyMedRadRes #medicine

CT 👇

Answer: Acute hypertensive encephalopathy (PRES) w/ superior frontal sulcus pattern

🔷Typically, when we see and think of PRES we think of the dominant parietal-occipital pattern but it’s important to be aware of other less well known patterns

Read 5 tweets

Daniel Gewolb, MD

@daniel_gewolb

May 8

Distinguishing between pathologic & compression fractures can be difficult

Here are some tips to help in 🧵

#Neurosurgery #MedEd #medicine #neurology #radres #futureradres

🔷Some findings more suggestive of pathologic fracture:

1️⃣Other spinal mets

2️⃣Epidural mass, especially when encasing the cord

3️⃣Focal paraspinal mass (beware, sometimes hematoma in compression fracture can mimic paraspinal mass)

Read 8 tweets

Daniel Gewolb, MD

@daniel_gewolb

Mar 23

Neuroimaging checklist for the patient with Temporal Lobe Epilepsy (TLE) 🧠 ✅

Credit to the excellent talk on the @TheASNR fellowship curriculum given by @EMiddlebrooksMD for inspiration on this topic

#MedEd #medicine #radres #Neurology #Neurosurgery #futureradres

1.Encephalomalacia (usually from old infarct, trauma, etc.)
2.Mesial Temporal Sclerosis
3.Sphenoid encephaloceles
4.Prominent arachnoid pits (may be encephalocele precursors)
5.Temporal lobe epilepsy with Amygdala enlargement
6.Focal Cortical Dysplasia

7.Polymicrogyria
8.Gray matter heterotopia
9.Tumors
10.HSV encephalitis
11.Autoimmune encephalitis
12.Hypothalamic hamartoma
13.Other infections (NCC, TB, etc.)
14.Incomplete hippocampal inversion (uncertain significance)
15.Others, please add 🙏

Read 20 tweets

Daniel Gewolb, MD

@daniel_gewolb

Feb 2

What is the most likely diagnosis in this 70 y/o w/ history of pontine infarct ~8 months ago now presenting with worsening ataxia and dysmetria?

#MedEd #radres #Neurology #neurosurgery #futureradres #Radiology

Answer (probable): Wallerian degeneration of the pontocerebellar fibers

🔷I only have 1 time point w/o follow up nor images of the pontine infarct. This patient also had cirrhosis. It is possible that the tracts have degenerated due to hepatic encephalopathy or other process

🔷Regardless of the cause in this case, it is important to be aware of these fiber tracts and their appearance when degenerated. Additionally, many other diagnoses can look similar and involve the bilateral middle cerebellar peduncles w/ differential in 🧵

Read 14 tweets

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