MS demyelenation? Encephalitis? | Figure 1

MS demyelenation? Encephalitis?

Patient presents with new trigeminal parenthesis (RT), intermittent RT vertical strabismus, intermittent RT ptosis, RT blind spot (intermittent), urinary urgency, fecal urgency, characteristic MS hug, intermittent searing pain down both legs and flanks. Normal EMG. Let me know if you require different images from the non-contrast MRI. Uncertain ddx.

Additional Cases

Axial T1 FLAIR MRI shows subependymal gray matter heterotopia (arrowhead), the most commonly observed form of gray matter heterotopia. The differential diagnosis for this finding includes subependymal nodules that occur in tuberous sclerosis complex. Gray matter heterotopia is distinguished from subependymal nodules of tuberous sclerosis by the signal intensity of the nodule; in tuberous sclerosis, the T2 signal of subependymal nodules is higher than that of normal gray matter while nodules in gray matter heterotopia are isointense to gray matter. Patients with tuberous sclerosis may also have additional stigmata such as subcortical tubers and subependymal giant cell astrocytomas.

64 yr old male, unsure where mets originated— hilar mass noted & awaiting EBUS biopsy. Adrenal mass notes & awaiting biopsy in IR. Known PMH smoker, etoh, COPD. Presuming primarily untreated lung cancer? Despite intubated, on light sedation, patient nods/gestures appropriately & follows commands. Rad Onc is following case as well as palliative.

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.

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.

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.