⭐️What is the most likely diagnosis in this patient presenting with a lump on the head?

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🔷What is the most likely diagnosis and clinical syndrome in this patient with left ear pain, cranial nerve 6 palsy, and retro-orbital pain? 🧠 🤔

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⭐️ Answer: petrous apicitis complicated by brainstem abscess

🔷Petrous apicitis can display the clinical triad of Gradenigo’s syndrome

1️⃣Otorrhea
2️⃣Cranial nerve 6 palsy
3️⃣Pain in distribution of trigeminal nerve

⭐️ What is the most likely diagnosis in this pregnant patient presenting with seizures? 🧠

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⭐️ Answer: Cortical vein thrombosis (CVT)

▶️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

🔷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🦇)

🔷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? 🧠

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⭐️ 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

⭐️ 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

⭐️ 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 👇

⭐️ Venous variants and abnormalities are the most common causes of pulsatile tinnitus

Differential and learning points in 🧵

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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

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

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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)

⭐️ What is the most likely diagnosis in this asymptomatic patient? What would your recommendation be if any?

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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

⭐️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 ⬆️

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⭐️ Answer: Transient Perivascular Inflammation of the Carotid Artery (Carotidynia or Fay syndrome)

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
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⭐️ Classic case: 45 y/o Female presents w/ intermittent R pulsatile tinnitus for 1-2 years, what’s the most likely diagnosis?

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Answer: Glomus Tympanicum Paraganglioma

🔷PATHOLOGY: Benign tumor arising from glomus bodies along the inferior tympanic nerve (Jacobson nerve)

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

🔷What is your best guess and differential?

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55 y/o F w/ no significant PMH presents with headache and bump on the head. What’s the most likely diagnosis? 🤔 🧠

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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? 🧠

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Answer: Multiple System Atrophy Cerebellar Type (MSA-C)

🔷MSA is an adult onset sporadic neurodegenerative disease presenting w/ motor and autonomic symptoms

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

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🔷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

What is the finding in this 55 y/o asymptomatic patient? Any associations? 🤔

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Answer: Hypothalamic adhesion

🔷This finding is incidental in most patients though the neuroradiologist should look for subtle midline and other associated abnormalities particularly in children

🔷Reported associations:
Gray matter heterotopia
Midline anomalies

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

CT in 🧵

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CT 👇

Distinguishing between pathologic & compression fractures can be difficult

Here are some tips to help in 🧵

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🔷Some findings more suggestive of pathologic fracture:

1️⃣Other spinal mets

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

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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