adult and pediatric neuroradiologist, opinions are my own (whose else could they be? 😊)
Italia
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Veeeeeery interesting medico-legal case, beautifully illustrated by @francisdeng : I feel like I could easily be Radiologist #1, maybe mentioning the L4 lesion as a possible “atypical vertebral venous malformation” (so called “hemangioma”) 🤦🏼♂️
Malpractice case: lumbar spinal mass, $1M verdict.
Take a look at these MR images from a separate teaching case of the same pathology and site as the litigant.
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Lorenzo Pinelli retweeted
🧠 What imaging patterns should radiologists recognize in autoimmune encephalitis?
This review explores the diverse appearances of AE, from limbic involvement to cortical, basal ganglia, brainstem & cerebellar findings, with key differential diagnoses.
pubs.rsna.org/doi/10.1148/ra…
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“Cerebral palsy” that is getting worse? Think again.
Early-onset hereditary spastic paraplegia (HSP) is an under-recognised mimic of CP, particularly when there is:
-Progressive spastic gait
-Loss of previously acquired motor skills
-True weakness
-Knee recurvatum
-Dystonia or parkinsonism
No family history does not exclude HSP. Early genetic testing can be key, especially as mechanism-targeted therapies begin to emerge. loom.ly/akigKf0
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Next step in global collaboration and free exchange of ideas and knowledge! Break away from the hierarchical system and join @thecortexclub, where everyone has a voice!
@roondoctors @RamVaidhyanath @LorenzoPinelli
Excited to announce that @thecortexclub is now on @roondoctors! Come and say hi to us there!
@RamVaidhyanath
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😳 Never heard about this, thank you for sharing! 🙏🏼
I don't know how many CTAs you have to read before you miss this vertebral artery variant, but its taken me 25 years and thousands to find one: Ascending Thoracic Vertebral Artery Variant. Nice paper in AJNR with description, cases, and diagrams. Talk about going around the thumb to get to the elbow. This case presumably incidental.
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An outpatient undergoes CTA neck to follow up carotid artery stenosis. What happened?
Radiology Diagnosis Please, Case 335 (Nov 2024): doi.org/10.1148/radiol.24160…
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30yo with recurrent persistent headaches
Prior surgical history: Chiari decompression (didn't help), pituitary surgery (normal tissue)
This is a subtle diagnosis that was initially overlooked. What do you suspect?
Answer to follow
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Lorenzo Pinelli retweeted
We need to be teaching our students and trainees how to think with machines without letting them think for us.
"We now need to teach them how to interrogate an AI output: how to ask, how to doubt, how to verify, how to recognize hallucination, how to see when a fluent answer has outrun the evidence, and how to preserve the aspects of clinical reasoning that cannot be outsourced."
nejm.org/doi/full/10.1056/NE…
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Tricky case! (one more proof that most of times the [neuro]radiological diagnoses are CLINICO-[neuro]radiological ones) 👏🏼
⭐️ What is the most likely diagnosis in this 50 y/o F who initially presented with uveitis which did not respond to steroids? Over the course of months, she progressively declined and eventually developed encephalopathy.
🔷No significant PMH
🔷CT chest, abdomen and pelvis unremarkable
🔷No significant response to steroids or IVIG
🔷Pathergy testing and HLA-B51 negative
🔷Serum ACE & IL2-R negative
#futureradres #MedEd #radres #neurosurgery #ENT #Ophthalmology #Neurology @RadiologyACR @Radiopaedia
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🔷Notice, lymphoma in this case is producing the “waterfall” or “cascade” sign. Neuroradiologists know that most signs are not as specific as the literature makes them seem. It is best to understand the mechanism of the sign rather than to blindly associate it with a disease. The mesodiencephalic junction (location of the waterfall sign) is a convergence of densely packed white matter tracts, perforating small vessels & periependymal AQP4-rich astrocytocytes, thus ANY process causing edema, perivascular inflammation, or neoplastic infiltration in this location can cause the waterfall sign.
For more reading 📖
pubmed.ncbi.nlm.nih.gov/4121…
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We use Bayesian reasoning in medicine. we don’t require proof beyond a reasonable doubt.” This lesion is classic for a PVS. Can we be 100% certain? No. But ordering an MRI for every classic PVS carries potential harms for patients and costs to the healthcare system.
From a strictly localization perspective, that wouldn’t cause right sided weakness.
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Since I found one more neurologist who blocks people disagreeing with their neuroradiological diagnoses, I post here my answer to previous @BumblebeeJoe post on the topic of PVS vs lacunar infarct.
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If I ever needed a neuroradiologist consultant (hopefully never!), I’d know whom to appoint! 👏🏼👏🏼👏🏼 @francisdeng
63-year-old man presents with syncope.
ED: CTA head and neck
This finding in the intradural left vertebral artery is alleged to have been missed (real case image).
The malpractice complaint states the patient re-presented 9 hours later with distal embolization to the basilar artery (subocclusive) and left superior cerebellar artery (occlusive), resulting in permanent injury.
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One of the strangest assumptions in healthcare is that an MRI is an MRI, a CT is a CT, and a PET scan is a PET scan.
They aren't.
The scanner matters.
The protocol matters.
The technologist matters.
The radiologist matters.
Two facilities can perform an exam with the same CPT code and produce very different diagnostic information. And very different prices....
Yet patients are generally given almost none of this information when choosing where to go.
We publish restaurant menus, hotel photos, car specifications, and phone benchmarks.
But for a medical test?
"Here's the address."
Imaging should be more transparent than that.
Know the machine.
Know who is reading it.
Know your options.
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The amazing “brain & neck CTA” Twitter series from @francisdeng (I assume triggered by a recent Twitter discussion on CTA in dizzy patients) keeps going on, unrevealing one more tricky, dangerous and game changing finding. CTA is NOT an easy and fast-reading exam! 👏🏼👏🏼👏🏼
Patient with history of stroke presents with an episode of lightheadedness followed by loss of consciousness x20 min. Seizure en route to ED.
Brain attack team activated. Take a look at this CTA head and neck here and see if anything pops out.
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🧠 Mentored Patient Study Collection
Neonate with history of prematurity (born at 31 weeks gestation), intrauterine growth restriction and
respiratory distress. Prenatal US showed ventriculomegaly. Head US performed for assessment of hemorrhage and ventriculomegaly. MRI performed at 37 weeks corrected age for further assessment.bit.ly/4y0cKL0
Ashley Williams MD MPH, New York Presbyterian Hospital/ Columbia University – New York, NY and Sara Reis Teixeira MD PhD, Children’s Hospital of Philadelphia, University of Pennsylvania – Philadelphia, PA
#PediNeuroRad #MedEd #FOAMrad #PedsRad #ASPNR
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@whitfieldlewis6 rails against the use of the HINTS exam, but doesn't know when to use it or how to interpret it. When I called him on it, he blocked me. It's ok to not use HINTS, but don't campaign against when you don't understand it.
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