▶️CVT causes retrograde venous pressure leading to focal vasogenic edema
▶️Increased back pressure is characterized by dilated veins and petechial hemorrhage which can progress to large hematomas and ischemic neurological damage
Jun 22 • 5 tweets • 3 min read
🔷What is the most likely diagnosis in this 70 y/o F who lives with feral cats presenting w/ vomiting, diarrhea, leukocytosis, fever for 3 days and progressive decline in level of consciousness?
🔷CSF: initially normal, repeat a few days later ⬆️ WBC (lymphocyte predominant), ⬆️ Protein, normal glucose
⭐️ Answer: Viral encephalitis (Specifically Rabies)
🔷 South Central Asia and Southeast Asia appear to have the greatest number of cases
🔷Dogs are the most common reservoir 🐶 (bats in developed countries🦇)
Jun 19 • 6 tweets • 3 min read
🔷35 y/o F w/ history of Li Fraumeni syndrome presents w/ intermittent left sided weakness and pain. The feeling is of heaviness, difficulty w/ grip, dropping objects and frequent falls. Episodes last for weeks to months. What is your diagnosis? 🧠
🎉Congrats to all the rad fellow matches today!!! 🍾
#Neurology #MRI #MedEd #medicine #neurosurgery #radres #futureradres #FOAMed @TheASNR
⭐️ Answer: Tumefactive demyelination (MS in this case)
🔷Imaging in this case is specific enough to diagnosis with confidence but we need extra caution in patients with genetic predisposition to malignancy
💡 In cases where imaging or clinical picture are atypical or discordant for demyelination (especially if there is a genetic disorder), it is best to refer to neurology for proper work up, possible trial of steroids and short imaging follow up
Apr 26 • 7 tweets • 3 min read
⭐️ What is the most likely diagnosis in this 45 y/o M found down with history of polysubstance abuse?
⭐️ 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?
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🔷Comparison from ~4 months ago 👇
Feb 12 • 23 tweets • 11 min read
⭐️ 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:
What is the most likely diagnosis in this 55 y/o F presenting w/ 2 years of progressive gait instability, mild dysarthria, bilateral dysmetria, & mild left bradykinesia? 🧠
#MedEd #neurology #radres #futureradres #medicine #Neurosurgery #FOAMed @AlbanyMedRadRes @PennRadiology
Answer: Multiple System Atrophy Cerebellar Type (MSA-C)
🔷MSA is an adult onset sporadic neurodegenerative disease presenting w/ motor and autonomic symptoms
Aug 31, 2024 • 10 tweets • 6 min read
Difficult case, let’s run this together. 70 y/o M w/ Hx of HTN presents with acute confusion, dysarthria and facial droop
🔷This finding is incidental in most patients though the neuroradiologist should look for subtle midline and other associated abnormalities particularly in children
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