⭐️ 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

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)

⭐️ 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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Additional image 👇
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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?

🔷More images in 🧵
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🔷More images 👇

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

More images in 🧵

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More images 👇

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

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 🧵

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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? 🤔

#MedEd #medicine #neurology #neurosurgery #ENT #FOAMed #futureradres #radres
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

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?

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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

What is the most likely diagnosis in this 75 y/o M w/ history of Alzheimer’s disease on lecanemab (last infusion ~1 week prior) presenting w/ headache and confusion? 🧠

More images in 🧵

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More images 👇

Imaging Quick Tips & Tricks for Cranial Neuropathies 🧠

A neuroimaging 🧵 on check areas and pathology

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💡 General imaging tips:

1️⃣Big issues and certain cranial nerves see on routine MR
2️⃣Thin slice high res axial and coronal T2 sequences (FIESTA, CISS, SPACE, etc.) useful for cisternal segments
3️⃣T1C- and T1C+ w/ fat sat best for extracranial segments
4️⃣CT often complementary

What is the most likely diagnosis in this 25 y/o M presenting with right facial paralysis and pulsatile tinnitus?

More images in 🧵

#ENT #MedEd #Neurology #Neurosurgery #radres #futureradres @ASHNRSociety





More images 👇

Intracranial HYPOtension, imaging findings and diagnostic approach

Imaging and learning points in 🧵 🧠

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Clinical:

▶️Headache that is worst when upright and improves with lying flat as it gets the sagging brain off the jagged skull base (at least that’s how I remember it)

💡May also present with chronic headaches or without headaches