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Lea Alhilali, MD

@teachplaygrub

Jun 14

1/Like a bad piano player in a run down bar--I take requests! By popular demand, a🧵on how I make those illustrations for my #tweetorials--all in #PowerPoint!
This one shows how to create shadow & highlights to give a 3D effect
#medtwitter #MedEd #FOAMed #powerpointpresentation

2/Let's use this french fry illustration I used for my varices🧵
I use the curve function to create shapes. It has the most control for drawing--the freeform function causes uneven lines.
After drawing the shape, I use the shape fill function to fill it in it w/the color I need

3/ 3D effects begin w/the gradient fill. I use the gradient fill that powerpoint offers for my selected color--it knows how to chose them so that the gradient is smooth

Read 10 tweets

Lea Alhilali, MD

@teachplaygrub

Jun 10

@MedTweetorials

1/ Is the voice box a black box for you?! Let's open the pandora's box of the anatomy of the #larynx together

An introductory #tweetorial on laryngeal #anatomy and the supporting structures. #FOAMed #medtwitter #meded #neurorad #HNrad #FOAMrad #medstudenttwitter @MedTweetorials

2/Everyone needs some support. Just like the tongue is supported by the hyoid, the main laryngeal support is the cricoid cartilage. It's like your favorite chair, with all the remotes next to it--not only does the cricoid provide support, it also connects structures in the larynx

3/ Although not official, the cricoid is like the real first ring of the trachea. Except it has an odd signet ring shape. The bulbous back part that makes it look like a signet ring provides the important articulation with the arytenoids

Read 11 tweets

Lea Alhilali, MD

@teachplaygrub

Jun 8

@MedTweetorials

1/Mike Tyson once said, “Everyone has a plan until they get punched.”
In honor of all the great hooks and crosses—here is a #tweetorial about mandibular fxs! #FOAMed #medtwitter #Meded #neurorad #HNrad #FOAMrad #Medstudenttwitter @MedTweetorials

2/A key concept in these fxs is dental occlusion. The jaw is meant to chew. To crush food, teeth need to come as close together as possible—occlusion. Each tooth needs to meet up with its counterpart that fits with it, so no room is left for food—and food will be crushed.

3/Occlusion can be lost w/a fx. The importance of dental occlusion makes mandibular fxs different from other fxs. Usually, we want to fix a bone so that it lines up again. But for the mandible, we want to fix it so the TEETH line up again—so chewing will work.

Read 14 tweets

Lea Alhilali, MD

@teachplaygrub

May 30

@medtweetorials

1/CSF leaks are controversial Some say they are overdiagnosed, others underdiagnosed. How can you make sure you aren’t under or over diagnosing?
A #tweetorial about a brain MRI score for suspected CSF leaks #medtwitter #FOAMed #radres #neurorad #FOAMrad #csfleak @medtweetorials

2/
With CSF leaks, everyone knows about brain sagging. But this can happen w/other pathologies, ie Chiari 1. Other findings can be seen on brain MRI in CSF leaks. But what are these findings? Are some findings more suggestive than others? Do more findings = ⬆️suspicion?

3/Dobrocky et al. looked at 9 quantitative & 7 qualitative signs seen on brain MRI in CSF leaks to see which are most important. Depending on type & # of findings, they developed a score to indicate what level of suspicion you should have for a leak.
pubmed.ncbi.nlm.nih.gov/30776059/

Read 12 tweets

Lea Alhilali, MD

@teachplaygrub

May 20

1/
Everyone loves those pretty colored fMRI pictures with the blobs. But what do they mean? How do they make them?
A #tweetorial called “F— that: Understanding fMRI”. #FOAMed #medtwitter #Medstudenttwitter #neurotwitter #FOAMrad #neuroradiology #radiology

2/
fMRI is based on a principle called “neurovascular coupling.” This is the principle if there is increased neuronal activity in a region, there will be increased blood flow to that region to meet the increased demand

3/
Think of it like a baby crying because it is hungry—parents immediately rush to feed it. The increased oxygen demand of the neurons immediately brings increased fuel to feed it.

Read 17 tweets

Lea Alhilali, MD

@teachplaygrub

May 18

1/
“You don’t get points for having your needle in the right place if you don’t get a diagnosis.” When we biopsy the skullbase we work to get a diagnosis.
A sort of #tweetorial but more like a 🧵about our skullbase biopsy system. #FOAMed #medtwitter #neurosurgery #neurotwitter

2/
Unless the lesion is difficult to diagnosis w/FNA (ie, schwannoma), we begin by FNA w/an 18g draw needle & a 22g Quincke needle. We do not aspirate, b/c the skullbase is very vascular, & too much blood will be drawn up, making it difficult to tell if the sample is diagnostic.

3/
However, if we are not getting a diagnosis with FNA, we will move to a core. If it is a deep lesion, we will use the Biopince system, beginning with a 17g, 7 cm introducer. This is an example of IgG4 disease of the trigeminal nerve that failed FNA and required a core

Read 7 tweets

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