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More from @teachplaygrub

Lea Alhilali, MD

@teachplaygrub

Sep 15

1/Time is brain!

So you don’t have time to struggle w/that stroke alert head CT.

Here’s a thread to help you with the CT findings in acute stroke!

2/CT in acute stroke has 2 main purposes

(1) exclude hemorrhage (a contraindication to thrombolysis)

(2) exclude other pathologies mimicking acute stroke. But you can also see other findings to help diagnosis a stroke.

3/Infarct appearance depends on timing.

In first 12 hrs, the most common imaging finding is…a normal head CT

However, you may see a hyperdense artery or basal ganglia obscuration. Later, you see loss of gray white differentiation & sulcal effacement

Read 13 tweets

Lea Alhilali, MD

@teachplaygrub

Sep 12

1/Do you feel there’s a back-log of findings in a spine MRI report?

Everyone talks about discs & facets, but not everyone talks about the endplates

Do you?

Do you need to talk about degenerative changes (Modic changes) of the endplates?

Here’s thread w/all you need to know!

2/Over 30 years ago, Modic et al. found there were 3 types of degenerative endplate changes:

(1) T2 bright changes (indicating edema, Modic 1)
(2) T1 bright changes (indicating fat, Modic 2)
(3) T1 & T2 dark changes (indicating sclerosis, Modic 3)

But what do they mean?

3/Let’s start w/Modic 1.

These are bright on T2, indicating edema

On pathology, it’s what you’d expect w/edema: inflammation, vascular granulation tissue, & high cellular turnover

Vascular granulation tissue means these can enhance on post contrast images—mimicking discitis!

Read 18 tweets

Lea Alhilali, MD

@teachplaygrub

Sep 10

1/Are you FISHING for a way to better evaluate subarachnoid hemorrhage?

Are you hungry for a way to classify these patients?

Donut you worry!

Here’s a short thread to help you remember the modified Fisher scale for classifying subarachnoid hemorrhage.

2/Just think of the brain as a donut. Like a donut, it’s a bunch of stuff around a hole in the middle.

Ventricles are the hole in the middle of the brain just like there’s a hole in the middle of the dough in a donut.

Just don’t quote me to your neuroanatomy professor….

3/Subarachnoid hemorrhage (SAH) added to the brain makes it less healthy, the same way adding toppings to a donut makes it less healthy.

Increasing severity of SAH is like increasingly unhealthy donut toppings. Fisher scale quantifies the vasospasm risk for increasing SAH

Read 8 tweets

Lea Alhilali, MD

@teachplaygrub

Sep 8

1/Talk about twisting your back!

Do spine vascular lesions make your brain feel as tangled as the dilated vessels you see?

Want some more information on malformations?

Here’s a thread on spine vascular anatomy to give you durable knowledge on dural arteriovenous fistulas (dAVF)

2/To understand spinal dural AVFs, you need to understand basic spinal vascular anatomy.

The spine is LONG—to get blood from the top to the bottom is like going through the length of a marathon course

3/So we will need to tackle it like you tackle running a marathon.

When you run a marathon, you replenish yourself at aid/water stations along the way so you can make it all the way through.

Same w/spinal arterial vasculature—it needs to be replenished on the way down.

Read 19 tweets

Lea Alhilali, MD

@teachplaygrub

Sep 3

1/Does the work up for dizziness make your head spin?

Wondering what to look for on an MR for dizziness

This month’s @theAJNR SCANtastic will tell you all you need about imaging Meniere’s disease!

ajnr.org/content/46/8/1…

@TheAJNR 2/The etiology for dizziness can have very diverse causes—each with very different treatments.

So it is important to try to differentiate

Meniere’s is a common cause & we can help diagnose it w/imaging!

@TheAJNR 3/To understand Meniere’s disease, you must know labyrinth anatomy

It has layers, like Russian nesting dolls. Outer doll is the bony labyrinth, holding perilymph & a second doll—membranous labyrinth.

Inside the membranous labyrinth is endolymph

Read 13 tweets

Lea Alhilali, MD

@teachplaygrub

Aug 1

1/They say form follows function!

Brain MRI anatomy is best understood in terms of both form & function.

Here’s a short thread to help you to remember important functional brain anatomy--so you truly can clinically correlate!

2/Let’s start at the top. At the vertex is the superior frontal gyrus. This is easy to remember, bc it’s at the top—and being at the top is superior. It’s like the superior king at the top of the vertex.

3/It is also easy to recognize on imaging. It looks like a big thumb pointing straight up out of the brain. I always look for that thumbs up when I am looking for the superior frontal gyrus (SFG)

Read 12 tweets

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More from @teachplaygrub

Lea Alhilali, MD

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Lea Alhilali, MD

Lea Alhilali, MD

Lea Alhilali, MD

Lea Alhilali, MD

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