⭐️ 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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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 👇

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 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 🧵

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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

What is the most likely diagnosis in this patient with sensorineural hearing loss and fullness of the neck? 🧠

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Answer: Pendred syndrome

▶️Pendred syndrome is an inherited cause of deafness

▶️Modiolar deficiency and vestibular enlargement are invariably seen

▶️Enlarged vestibular aqueducts are often seen

What is the most likely diagnosis in this patient with a left base of tongue mass and a negative biopsy?

Couple more images in 🧵

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Distinguishing between pathologic & compression fractures can be difficult

Here are some tips to help in 🧵

#neurosurgery #Neurology #neurotwitter @The_ASSR #radres #futureradres #MedEd





Some findings more suggestive of pathologic fracture:

1️⃣Other spinal mets

What is the most likely diagnosis in this 25 y/o M who was found down? 🧠

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Answer: Cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome

▶️CHANTER syndrome is a distinct pattern of imaging manifestations representing a form of opioid induced neurotoxicity

Incomplete hippocampal inversion is an uncommon finding in patients without epilepsy

💡 The finding should heighten suspicion for a seizure disorder

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Imaging:
▶️ROUNDED morphology with more vertical and medial orientation (yellow arrow)
▶️DEEP more VERTICALLY oriented COLLATERAL SULCUS (blue arrow)
▶️Blurred hippocampal structure
▶️NORMAL SIZE AND SIGNAL (different from MTS)
▶️Enlarged-appearing temporal horn 🧠

Hypertensive and cerebral amyloid angiopathy are 2 of the most common causes of intracranial micro-hemorrhage 🧠

💡Recognizing the pattern of micro bleeds can help determine etiology
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💡 Typical hypertensive micro bleed pattern (best seen on SWI/T2*):
▶️Deep gray matter
▶️Brainstem
▶️Less commonly, peripheral

💡 Hypertensive angiopathy can result in both hemorrhage or ischemia

Differential Diagnosis for cortically based masses

P-DOG 🐶

1️⃣Pleomorphic Xanthoastrocytoma (PXA)
2️⃣Dysembryoplastic neuroepithelial tumor (DNET)
3️⃣Oligodendroglioma
4️⃣Ganglioglioma
#Neurology #neurosurgery #peds #radres #neurotwitter @The_ASPNR @TheASNR #MedTwitter 1️⃣PXA

Originate in the subpial astrocytes typically in children and young adults often with a seizure history

Temporal lobe is most common

Tuberculous Meningitis in this child w/ fevers and lethargy

💡 COMMUNICATING HYDROCEPHALUS with DEEP INFARCTION is highly suggestive of granulomatous meningitis
#neurology #MedTwitter #neurotwitter @TheASNR #MedEd #futureradres ▶️In children, primary TB infection is commonly associated w/ meningitis

▶️Exudative meningitis of the basal cisterns can obstruct the normal CSF flow resulting in hydrocephalus