🦢I have to admire the “Kiss Swan” sign 🦢 🔎Once you see the two swans facing each other in the medulla, it is remarkably convincing: preserved gray matter outlined against the abnormal T2-hyperintense white matter. 👏Beautiful neuroradiologic pareidolia. doi.org/10.1212/WN9.00000000…

✅Papillary tumor of the pineal region. 💡PTPR can closely mimic pineocytoma on imaging. In an adult pineal mass, keep it in the differential, especially when pathology is equivocal. Craniospinal MRI is advisable because neuraxial dissemination can occur. doi.org/10.7759/cureus.11586…

👷‍♀️45-year-old woman with a 1-year history of progressive headache, visual disturbance, and gait imbalance. Examination shows papilledema and mild upward gaze palsy. No known malignancy or relevant medical history. 🏥What is your differential for a pineal-region mass?

✅Primary neuroendocrine carcinoma of the brain. 💡Intracranial neuroendocrine tumors are usually metastatic. A primary CNS origin requires exclusion of an extracranial primary, and prolonged surveillance may be warranted because very late recurrence can occur. doi.org/10.1136/bcr-2019-230…

👱‍♀️34-year-old woman with headaches, nausea and vomiting. Tumor tissue was strongly positive for synaptophysin/chromogranin, focally positive for neurofilament, and negative for GFAP, NeuN, S100, TTF1 and CDX2. PET/CT found no extracranial primary. 🥼What is your differential?

✅Tubulonodular pericallosal lipoma with corpus callosum dysgenesis. 💡This variant is typically anterior and >2 cm thick, often associated with callosal anomalies. Fat suppression confirms its lipomatous nature; peripheral calcification may occur. dx.doi.org/10.35366/104281

✅Neurosarcoidosis. 💡Periventricular and intraventricular enhancement with obstructive hydrocephalus should raise this possibility, especially with systemic sarcoidosis. Infection and metastatic disease remain key mimics. doi.org/10.7759/cureus.11578…

👦7-year-old boy with headache, impaired motor coordination, balance problems, and expressive language difficulties. 🧑‍⚕️What is your differential diagnosis?

🧑‍🦰23-year-old man with recurrent stereotyped episodes of isolated aphasia over 1 week. He is being investigated for >1 month of persistent hiccups/vomiting, with mediastinal and mesenteric lymphadenopathy. 🥼Differential?

🍋Lemon sign. 💡Bifrontal concavity on fetal axial US is a classic marker of spina bifida. It is most useful before 24 weeks and should prompt a careful search for spinal defects and other cranial markers, including the banana sign. dx.doi.org/10.1016/j.rard.20…