2/Coming from anterior, the first lobule is the lingula. It sticks out from the front of the vermis & is connected to the superior cerebellar peduncle. I remember this bc it has a very appropriate name—lingula—it looks like a tongue sticking out of the vermis to lick the SCP.
3/Moving clockwise, next is the central lobule. I remember this bc it is positioned exactly how a central lobule should be positioned, in the driver’s seat—where the front seat driver position would be if the vermis was a car—up front, looking out the windshield over the lingula
4/Next lobule over is the culmen. I remember this bc culmen sounds like culminate—which means to reach the highest altitude—and that’s what the culmen is—it is the highest point—the mountain peak of the vermis.
5/Next is the declive. This is easy to remember bc after reaching the peak of the culmen, what happens next? We have to go down or decline = declive. The declive is the lobule that starts to go down after the culmen—not unlike our current stock market 😬
6/After declive is the folium. I remember this bc it looks like a thin fern branch, or “foliage,”with a thin stem and just a thin layer of leaves
7/The tuber follows the folium. It is similar to the folium, except instead of being thin like a fern branch, it is much chunkier, with thicker nodules on it. Hence its name is easy to remember—tuber means potato, and this lobule has a fatter, rounder contour like a potato.
8/As we continue around, next is the pyramid. This one is easy to remember—it is triangular like a pyramid, and hence its name
9/Hanging down from the bottom of the vermis is the uvula. It is easy to remember how they named this one. It hangs down from the vermis just like your uvula hangs down from the roof of your mouth.
10/Last is the nodule. I remember this bc nodule sounds like nose--and it even looks like a nose—pointing out from the middle of the vermis the way the nose points out of the middle of your face.
11/”Ok,” you might say, “Now I can remember the names, but how can I remember the order?” I’ve got your back. The vermis is important for truncal balance, so my mnemonic is “Let’s Count the Cerebellar Design for Truncal Posture and Unsteadiness.”
12/So now you know how to remember all the lobules of the vermis and have a mneumonic to remember their order. May your knowledge continue to culminate and never declive!
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1/ I always say, "Anyone can see the bright spot on diffusion images—what sets you apart is if you can tell them why it’s there!”
If you don't why a stroke happened, you can't prevent the next one!
Can YOU tell a stroke’s etiology from an MRI?
Here’s a thread to show you how!
2/First a review of the vascular territories.
I think the vascular territories look a butterfly—w/the ACA as the head/body, PCA as the butt/tail, and MCA territories spreading out like a butterfly wings.
3/Of course, it’s more complicated than that.
Medially, there are also small vessel territories—the lenticulostriates & anterior choroidal.
I think they look like little legs, coming out from between the ACA body & PCA tail.
1/Asking “How old are you?” can be dicey—both in real life & on MRI!
Do you know how to tell the age of blood on MRI?
Here’s a thread on how to date blood on MRI!
After reading this, when you see a hemorrhage, your guess on its age will always be in the right vein!
2/If you ask someone how to date blood on MRI, they’ll spit out a crazy mnemonic about babies that tells you what signal blood should be on T1 & T2 imaging by age.
But mnemonics are crutch—they help you memorize, but not understand
If you understand, you don’t need to memorize
3/If you look at the mnemonic, you will notice one thing—the T1 signal is all you need to tell if blood is acute, subacute or chronic.
T2 signal will tell if it is early or late in each of those time periods—but that type of detail isn’t needed in real life
@TheAJNR 2/Since the prehistoric days of medicine (1979!), we knew that some brain tumor patients treated w/radiation (XRT) initially declined, but then get better.
Today, we see this on imaging, where it looks worse early, but then gets better.
Now we call this pseudoprogression.
@TheAJNR 3/Why does this happen?
XRT induces a lot of inflammatory changes—from initiating the complement cascade to opening the blood brain barrier (BBB)
It’s these inflammatory changes that make the imaging look worse.