Ariel Gershon

Medical Genetics Resident @uoftmedicine. Professional learner. Interested in #histmed, #meded, humanities, #tweetorials. Clerkship Director @Medskldotcom

[Ariel Gershon @GershonMD]

@danatsouza @BrighamRad @FOAMrad @SAR_RFS @futureradres @ARRS_Radiology @Abdominal_Rad @CBRadiologia diffuse type gastric cancer. CDH1 pathogenic variant in the germline would predispose to this and lobular breast ca.

[Ariel Gershon @GershonMD]

@leon_metlay @CraigHorbinski @NeuroOnc @TheUSCAP @neuropathology @BrainTumorInst @NU_Pathology @NeurosurgeryNM @Pathologists @yro854 Looks like Tris-acryl gelatin microspheres from Dr. Rosen's atlas: https://t.co/9RQiO5gfqD

[Ariel Gershon @GershonMD]

@CraigHorbinski @NeuroOnc @TheUSCAP @neuropathology @BrainTumorInst @NU_Pathology @NeurosurgeryNM @Pathologists they are intravascular. I vote for pre-sugical embolization. described clinically here PMID: 39800159

[Ariel Gershon @GershonMD]

@francisdeng the odor can first be detected in the cerumen (~24 hours of life) before it's present in the urine (~6 days)

[Ariel Gershon @GershonMD]

@Immanuel_Paul30 leiomyoma. Consider RCC predisposition - Hereditary Leiomyomatosis with Renal Cell Carcinoma caused by heterozygous FH variants. Note that homozygosity for pathogenic variants in FH is associated with fumarate hydratase deficiency (neonatal epileptic encephalopathy)

[Lea Alhilali, MD @teachplaygrub]

Is trying to remember toxic encephalopathy patterns making you toxic?

Does memorizing metabolic encephalopathy patterns put you into a metabolic coma?

Don't become encephalopathic!

Here is the cheat sheet of the encephalopathy patterns you NEED to know & how to remember them!

➡️Corpus Callosum:
🔸Lesions here are called cytotoxic lesions of the corpus callosum or CLOCC.
🔸Usually transient from cytotoxicity, especially viral infections.
🔸Remember they are commonly viral & transient bc CLOCC lesions are on the CLOCK

➡️Central Pons:
🔸Usually osmotic demyelination
🔸Remember this bc the T2 hyperintensity is in the shape of O for Osmotic

➡️Dentate:
🔸Usually flagyl toxicity
🔸Remember this bc the wavy appearance of the dentate looks like a FLAG for FLAGyl

➡️Corticospinal tract:
🔸Usually from cobalamin deficienty
🔸Remember cortiCOspinal for CObalamin

➡️Symmetric Gray Matter:
🔸Differential is EXTENSIVE
🔸Remember the differential list for deep gray is deep!

➡️Cortical Gray Matter:
🔸Typically hypoglycemia & hyperammonemia
🔸Remember it looks like the brain has been coated in shimmering sugar = related to glucose
🔸Hyperammonemia has about 1000 Ms in it & the undulated cortex looks like an M

➡️Symmetric White Matter:
🔸Commonly from chasing the dragon (heroin) & methotrexate
🔸Remember that the puffy white matter signal looks like the smoke from a dragon
🔸Remember methotrexate as methoTRACTSate = affects many white matter TRACTS

➡️Posterior subcortical edema:
🔸This is PRES or posterior reversible encephalopathy
🔸So if it’s all POSTERIOR, think POSTERIOR reversible encephalopathy

➡️Asymmetric White Matter:
🔸This is usually demyelinating from chemotherapy
🔸Demyelinating lesions have a C shaped pattern of enhancement
🔸So if you see a C enhancing think of C-hemotherapy

Now you know all the toxic/metabolic encephalopathy patterns.

So hopefully now remembering the patterns of toxic/metabolic won’t seem so diabolic!

[Ariel Gershon @GershonMD]

@DrCycloPath think of hereditary osteochondroma predisposition if multiple: (autosomal dominant, EXT1 or EXT2). Avg age of diagnosis ~3 years but up to 12 years. https://t.co/WZvIRCfDFy

[Ariel Gershon @GershonMD]

For #medicalstudents interested in emergency medicine: compete in a quiz on the toxicologic aspects of #salicylate. As usual there will be a quiz later! Apr 29th, 7pm EST https://t.co/djNSOlWYPC #medtwitter #foamed #EmergencyMedicine #toxicology #medicine

[Ariel Gershon @GershonMD]

@studyrare Crus of helix connected to antihelix.

[Ariel Gershon @GershonMD]

Apr 22nd, 7pm EST, learn about toxicology from ER staff physician Dr. Amar Chakraborty. For #medicalstudents take a deep dive on #salicylate toxicity. As usual there will be a quiz later! https://t.co/djNSOlXwFa #medtwitter #foamed #EmergencyMedicine #toxicology #medicine

[Lea Alhilali, MD @teachplaygrub]

If you aren’t cheating, you aren’t trying!

Are you looking at MRIs?

Feeling some confusion about the diffusion?

Feel impaired when it comes to the FLAIR?

Wish you could cheat a little?

Here’s a little cheat sheet on all the sequences you NEED to know if you are looking at MRIs!

➡️T1: It’s for anatomy, so brain structures reflect the same color as real life. So gray matter is gray on T1 & white matter is white on T1. It’s also for contrast. Contrast material is taken up by masses making them light up & them easier to see.

➡️T2: It’s the water sensitive sequence. What is pathologic water in the brain? Edema! My attending once said, “Everything bad in this world is trying to turn you back into what you came from—water."

➡️DWI: Diffusion detects stroke, which are bright on diffusion. But anything that makes space tight in the brain can be bright on diffusion (highly cellular masses, clotted blood, pus under pressure, etc.)

➡️Gradient: Gradient is sensitive to metals. And what’s the most important metal in body? Iron—bc iron is in blood. So gradient is our blood sensitive sequence

So keep this cheat sheet w/you whenever you have to look at MRIs!

Who says cheaters never win!

[Ariel Gershon @GershonMD]

@Path4People "fuzzy" actinomyces mass. She may have an IUD in place

[Ariel Gershon @GershonMD]

@Path4People @path_girl88 @Hashimoto__0 nice case! thank you for sharing.

[Ariel Gershon @GershonMD]

@PeterItebimien @IhabFathiSulima @BrownJHM @DrAkhilRaghavan @neuralconsult @NicoGagelmann @JAMADerm @dermatology @nihardesai7 @drkeithsiau @ManualOMedicine @ArunInamadar Fabry disease.
skin angiokeratoma: dark-purple papules.
cornea verticillate: fern-like linear branching opacity.
The history describes the typical pain crisis and acroparesthesias.

[Ariel Gershon @GershonMD]

@MSeidmanMD @SCVP1 @CVpathol @Marc_Halushka @joemaleszewski @MelanieBoisMD @IHC_guy @vidhyanair60 @thoracicpath @SheppardNoelle posttransplant ectopic lymphoid follicles. Can also be seen in viral myocarditis.

[Ariel Gershon @GershonMD]

@CraigHorbinski @NeuroOnc @TheUSCAP @neuropathology @NU_Pathology @NeurosurgeryNM can you make a pun with "physaliferous"?

[Ariel Gershon @GershonMD]

@StuffIGross uveal melanoma

[Ariel Gershon @GershonMD]

@studyrare dyskeratosis congenita. Classic triad is 1. dysplastic nails 2. oral leukoplakia 3. lacy reticulated pigmentary changes, esp of chest/neck skin. Important boone marrow failure, pulmonary fibrosis, and cancer predisposition syndrome: https://t.co/7C3dfT8CeI

[Ariel Gershon @GershonMD]

@JaredAhrendsen @neuropathology @TheUSCAP @Pathologists @NeuroOnc @NU_Pathology @NeurosurgeryNM @BrainTumorInst @LurieChildrens @Lurieneurosurg @NorthwesternMed atypical teratoid / rhabdoid tumor