👉🏿This illustration is in fact comprised of 4 individual elements (some are groups) that are created separately, but with the final piece in mind.
(I usually sketch🖌️ on paper w pencils the basic drawing that I aim to create, to get the general idea)
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Step 1: Curve tool - gives enormous control for drawing the basic shapes you need
➰Now, I have created the basic shape for the cortex 👇🏿
I will do a similar, but smaller shape for the white matter...
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Step 2: add color🎨("Shape fill" tool) and outline
(you can do fancy things like gradient fills, shadows, 3D, but let's go with a simple fill)
Step 3: layering🃏- you overlay shapes to create the whole
Now a basic piece of cortex and some white matter is taking shape..👇🏿
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Step 4: Correction of details with the "Edit points" tool under magnification
**each shape is comprised of individual connected points, you just don't normally see them!
I use this to make small alterations to shapes: change curvature of points, angle, add/delete points...
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Step 5: To create the blood vessel, I use again the Curve tool under magnification to make the outline of the shape, in this case a penetrating arteriole.
... add color, outline, edit points PRN
See for example a smaller arteriole in the making👇🏿
(you can sprinkle VEGF)
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As you would imagine, the more elaborate a shape is, the more painstaking the process of modifying the points is...
This is what I used for example to design the #cortical layers 👇🏿
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⚫️ Now, just for fun, let's add some @microbleeds in the cortex.
I draw a circe, paint it black, add a bit of black glow to represent the blooming effect on blood-sensitive MRI, make copies, and add them to the illustration 👇🏿
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🧠🏗️ And this is how you build a brain, piece (of cortex) by piece...
I use more or less the same method for more complicated illustrations.
The populations that this might be relevant to are:
- healthy elderly
- ischemic stroke
- memory clinic
- any pt who got a brain MRI for a different indication (e.g. migraines)
- non-ICH cerebral amyloid angiopathy (CAA)
🚨 🧵 Some pearls on cases I have seen last week during night call @bmcneurology@The_BMC 🧠
PRES, RCVS, Trigeminal autonomic cephalalgia, vertigo, IIH, hyperglycemic hyperosmolar syndrome, hyperK, SAH, a tone of CODES STROKE, a tone of seizures #NeuroTwitter#MedEd#Neurology
1/ PRES 🗜️
⚡️huge spectrum
⚡️high index of suspicion in ptns with risk factors (often with HTN urgency, immunosuppression, sepsis) + seizures
🕵🏻♂️may not be posterior, may not be reversible, may not present as a syndrome!! emcrit.org/ibcc/pres/@PulmCrit
2/
⚡️RCVS
-observe (MRI, CTA), remove triggers, be cautious not to miss a dissection @interneurona
-pain control, this is the worst imaginable pain: Mg IV, opioids
-CaCB may help with headache - no proved benefit for vasoconstriction @AneeshSinghalMD@CajalButterfly @UpToDate