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
Jan 12 • 15 tweets • 6 min read
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? 🧠
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
Dec 23, 2023 • 13 tweets • 5 min read
What is the most likely diagnosis in this 25 y/o M presenting with right facial paralysis and pulsatile tinnitus?
▶️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
Aug 28, 2023 • 8 tweets • 3 min read
What is the most likely diagnosis in this patient with sensorineural hearing loss and fullness of the neck? 🧠
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 🧠
Jul 1, 2023 • 5 tweets • 2 min read
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
#NeuroTwitter #radres #Neurology #Neurosurgery #MedEd #MedTwitter
💡 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
Jun 10, 2023 • 14 tweets • 10 min read
Differential Diagnosis for cortically based masses
▶️Susac syndrome is a microangiopathy (likely autoimmune affecting the precapillary arterioles) with a strong female predilection, typically occurring in women age 20-40
May 27, 2023 • 14 tweets • 7 min read
Tips & tricks of DWI to help narrow the differential
Ddx:
Stroke
Abscess
Hypercellular tumor
Hematoma
Epidermoid cyst
Encephalitis
Seizure
Demyelination
Toxic/metabolic disorders
CJD
Other stuff I’m forgetting #Neurology#neurosurgery#radres#MedTwitter#MedEd@TheASNR
Anything that traps fluid can restrict diffusion! Here are some tricks I use to narrow the ddx
1️⃣STROKE
Cytotoxic edema due to trapped intracellular fluid leads to restriction
Look for wedge shaped restriction in a vascular territory
May 25, 2023 • 7 tweets • 4 min read
Child with a history of dental caries presents with a firm mass at the angle of the mandible. What is the most likely diagnosis? 🤔 🧠