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Daniel Gewolb, MD Profile picture
@daniel_gewolb
Dec 23, 2022 • 3 tweets • 3 min read • Read on X
Child presents with weakness. MR shows enhancement of the pial surface of the conus and ventral cauda equina nerve roots.

#radtwitter #MedTwitter #radres #futureradres #Pediatrics #Neurology @TheASNR @The_ASPNR @AlbanyMedRadRes ImageImageImage
Differential diagnosis:

Leptomeningeal carcinomatosis
Lymphoma
Arachnoiditis (all causes)
Guillain-barre
Neurosarcoidosis
Diagnosis: Guillain-Barré syndrome

These are the typical imaging features for GBS. Contrast is absolutely necessary.

There was no history to suggest systemic sarcoidosis, malignancy, or recent procedure (risk factor for spinal meningitis/arachnoiditis)

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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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