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Daniel Gewolb, MD

@daniel_gewolb

Apr 26

⭐️ What is the most likely diagnosis in this 45 y/o M found down with history of polysubstance abuse?

#Neurology #Medicine #radres #Neurosurgery #futureradres #radres #FOAMed #MRI @AlbanyMedRadRes @TheASNR

⭐️ Answer: Opioid-associated amnestic syndrome

🔷Toxicology was + for fentanyl and no other parts of the brain were affected on MRI

🔷Pathophys: Unclear, possibly neuronal hyper metabolism and/or ischemic component

🔷Clinical: New-onset amnesia for >24 hours

🔷Imaging:
▶️Diffuse, symmetric diffusion restriction in the hippocampi

▶️Usually mild T2/FLAIR signal in same areas

Read 7 tweets

Daniel Gewolb, MD

@daniel_gewolb

Mar 19

⭐️ 30 y/o presents w/ R sided weakness & fall. Pt had a recent admission ~4 months ago for headache, AMS, seizure & diplopia. Clinically stable until now.

🔷LP 4 months ago: protein >600
🔷Comparison in 🧵

What is your diagnosis?

#medicine #MedEd #radres #futureradres #Neurology #Neurosurgery #FOAMed @TheASNR

🔷Comparison from ~4 months ago 👇

⭐️ Hint: TB work up negative and CT chest, abdomen and pelvis also negative. The spine was imaged 👇

Read 7 tweets

Daniel Gewolb, MD

@daniel_gewolb

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

🔷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

@daniel_gewolb

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

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)

Read 4 tweets

Daniel Gewolb, MD

@daniel_gewolb

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

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

@daniel_gewolb

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

⭐️ 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

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