👩A 34-year-old woman at 32 weeks of gestation, with type 1 diabetes, presents with sudden severe headache, projectile vomiting, right hemiparesis, and speech difficulties. GCS 14/15. No seizures or previous neurological symptoms. 🏥What is your differential diagnosis?

🧠Anatomical variants of the ACA–AComA complex were found in 34% of 283 patients on CTA. These include A1 hypoplasia or absence, fenestrations, azygos ACA, and triple ACA. 👌Recognizing them is essential for assessing collateral circulation and planning vascular procedures. dx.doi.org/10.4067/S0717-950…

✅Juvenile nasopharyngeal angiofibroma. 💡Look for anterior bowing of the posterior maxillary sinus wall (Holman-Miller sign), pterygopalatine fossa widening, and intratumoral flow voids. Avoid biopsy due to hemorrhage risk. Assess skull base and intracranial extension. doi.org/10.4103/2156-7514.10…

✅Normal fat deposits in the cavernous sinuses. 💡Seen in 20–27% of patients on CT. They may be more prominent in patients with obesity or Cushing syndrome. When the appearance is characteristic, no MRI or follow-up is needed. doi.org/10.3174/ajnr.A1398

👦A 14-year-old boy presents with a 1-year history of progressively enlarging palatal swelling, initially painless, followed by epistaxis, nasal obstruction, dysphagia, and right facial swelling. 🥼What is your differential diagnosis?

✅Cerebral sparganosis. 💡Look for tubular or bead-like enhancement, punctate calcifications, and adjacent volume loss rather than mass effect. The tunnel sign reflects larval migration. Lesion migration on serial MRI is a particularly valuable diagnostic clue. doi.org/10.3174/ajnr.A0659

☎️A resident calls you, concerned about a finding on a head CT. 😓“Should we recommend an MRI to investigate this further?” What would you do?

✅Obstructive hydrocephalus due to aqueductal compression by a developmental venous anomaly (DVA). 💡Mesencephalic DVAs can rarely cause aqueductal stenosis. Radially converging medullary veins and a collector draining into the vein of Galen support the diagnosis. doi.org/10.3897/folmed.64.e6…

🐸A 45-year-old woman with a 6-year history of severe headaches, intermittent seizures, and right hemiparesis. She reports eating undercooked frog meat 16 years earlier. 🏥What is your differential diagnosis?

👳‍♂️A 65-year-old man with recurrent conjunctival squamous cell carcinoma presents with gait ataxia, cognitive decline, and urinary and fecal incontinence. No history of head trauma. 🧑‍⚕️What is the underlying cause of his neurological symptoms?