Sagittal cut of the cerebelum allow us to study the structur | Figure 1

Germani96

Medical Student

Sagittal cut of the cerebelum allow us to study the structures of the fourth ventricle #Arborvitae

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Sagittal T1-weighted MRI through the left (image 1) and right (image 2) cerebellar hemisphere and axial T1-weighted (image 3) MRI in a patient with ataxia show diffuse cerebellar atrophy with widening of the cerebellar folia and cerebellar vermis. Spinocerebellar ataxia is a degenerative hereditary disorder. Patients initially present with ataxia. Other symptoms included difficulty of speech and swallowing, spasticity, ophthalmoplegia, nystagmus, and cognitive impairment.](https://app.figure1.com/case-detail/0aa847d8-1632-4bf9-978f-aca002da5606)



Axial T1-weighted image shows abnormal morphology of the brainstem with elongation of the superior cerebellar peduncles (arrow) and a molar tooth configuration consistent with Joubert syndrome. Joubert syndrome is characterized by hypoplasia or aplasia of the cerebellar vermis and an abnormal brainstem morphology. Infants present with hypotonia and ataxia. #NeuroWednesday](https://app.figure1.com/case-detail/463b589d-b915-491d-8933-f42ba66085f1)



I saw this patient, 23F from central america, with a Hx of 3 weeks "dizziness". Upon evaluation, not really dizzy, but right sided ataxia (difficult ambulation), R beating nystagmus, decreased sensation on R leg from toes up to hip level, mild hyperreflexia throughout and clonus bilat (3 beats).
MRI presented here, let's discuss dissemination in time and space concepts (DIT, DIS), CIS and what we consider typical vs atypical presentation.
We did not feel Oligoclonal bands would aid too much, as MS is a clinical diagnosis, but if you want to classify this as PPMS, then perhaps that's relevant.
DDX? let's discuss. Try to describe what you see on these pictures. FYI, there were various ring enhancing lesions post Gad (not shown). How do you meet DIT? and DIS?](https://app.figure1.com/case-detail/891d67e2-82fb-4072-bf43-5c2c920291b9)



A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.
He had a history of hypertension, long-term smoking, and a sedentary lifestyle.
On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)



A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.
Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)



A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de)



patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?](https://app.figure1.com/case-detail/2af390e1-ace8-40ed-ba1c-98fb2d72f4c5)