Lea Alhilali, MD Profile picture
Aug 11, 2022 • 6 tweets • 4 min read • Read on X
1/"You can put this diagnosis in the differential as many times as you want in your life, but you will only be right once," I told my fellow.
Ađź§µabout a dx you hear about but are rarely lucky enough to see #medtwitter #FOAMed #FOAMrad #medstudent #neurorad #radres #neurosurgery Image
2/Pt had a calcified lesion in the posterior fossa found incidentally on a trauma CT, that was now enlarging. It had very coarse, stippled appearing calcifications, like grains of sand or dirt Image
3/It also had very jagged, irregular margins, almost as if the grains of calcium had just been piled up together haphazardly Image
4/On MRI, it was very T2 dark (from the calcs) & demonstrated mild enhancement. It was extraaxial, but didn't appear to arise from the meninges. Rather, it was in the lateral cerebellomedullary cistern, where CN 9-11 arise. Image
5/So went back to the CT--left SCM & trapezius atrophy but no cord palsy! This means it's a CN11 lesion--not just affecting it from mass effect, then it would affect 10 also. Calcified schwannomas are rare. CN11 schwannomas are rare. Calcified CN11 schwannomas likely don't exist Image
6/Googling "calcified lesion CN11" gave us CAPNON--a rare, non-neoplastic, reactive process. It affects CNs & when it does, usually 11.We were right! So I've had my 1 time to be right about this. If you haven't, now you know what to look for to make this dx a feather in your CAP! Image

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More from @teachplaygrub

Apr 16
1/ Need a global perspective on dementia?

Do you know the global cortical atrophy (GCA) score for evaluating dementia patients—or are you still gestalting volume loss???

Don’t estimate when you can calculate!

Here’s a thread of what you need to know about the GCA score! Image
2/The global cortical atrophy score calculates cortical volume loss on a scale of 0-3 in 13 different regions & ventricular dilatation

Gyri shrink down w/atrophy, the same way your cheeks shrink down with aging! Image
3/Gyri look like lips with around a mouth of sulcal space.

Without volume loss, the gyri look like big fat pursed model lips

But w/volume loss they open up like the scream w/thinning of the lips Image
Read 9 tweets
Apr 14
1/Wish that your knowledge of autoimmune encephalitis was automatic?

Do you feel in limbo about limbic encephalitis?

Do you know the patterns?

Read on for what you need to know in this month's @RadioGraphics review!



@cookyscan1 @RadG_Editor doi.org/10.1148/rg.240…Image
@RadioGraphics @cookyscan1 @RadG_Editor 2/Two pearls:
(1) Most common pattern is limbic encephalitis
(2) Small cell can cause any autoimmune pattern.

You can remember the causes by the demographic:
Young man: testicular
Older: Small cell
Woman with psychiatric symptoms (limbic): breast Image
@RadioGraphics @cookyscan1 @RadG_Editor 3/Limbic encephalitis is the most common pattern

But it has many, many different causes

Remember--limbic involvement is shaped like a question mark!

So for limbic encephalitis, the cause remains a question bc differential is so broad

Must question & clinically correlate! Image
Read 8 tweets
Apr 2
1/One important aspect to stroke care is well, ASPECTS.

It’s a simple score system—but it’s important to understand all aspects!

Read on for the latest research on ASPECTS in this month’s @theAJNR SCANtastic!

ajnr.org/content/46/3/5…Image
2/ASPECTS stands for “Alberta Stroke Program Early CT Score.”

It’s meant to replace gestalt-ing what percent of the MCA territory is infarcted.

Instead, it uses a 10-pt score to semi-quantitate the infarcted tissue in the MCA territory on non-contrast head CT Image
3/You can think of it as a score card for the MCA.

For each region of MCA territory NOT infarcted, the pt gets one point—for a highest score of 10, and lowest score of 0 Image
Read 18 tweets
Mar 21
1/Don't fall for the siren song of calling all bright round objects at foramen of Monro colloid cysts.

Like a true siren song, this may be a TRAP!

If you hear the call of colloid—read this first!

Here's a thread about lesions here that can trap you--& how you can avoid them! Image
2/Here are 3 lesions, all round and bright and in the region of the foramen of Monro.

Can you tell from the images which is a colloid cyst and which may be something else?

Choose which one or ones you think are a colloid cyst! Image
3/In this case it was A!

B was a tortuous basilar

C was a cavernoma of the chiasm/hypothalamus that had bled and projected into the third ventricle. Image
Read 12 tweets
Mar 16
1/Remembering spinal fracture classifications is back breaking work!

A thread to review the scoring system for thoracic & lumbar fractures—“TLICS” to the cool kids! Image
2/TLICS scores a fx on (1) morphology & (2) posterior ligamentous complex injury

Let's start w/morphology

TLICS scores severity like the steps to make & eat a pizza:

Mild compression (kneading), strong compression (rolling), rotation (tossing), & distraction (tearing in) Image
3/At the most mild, w/only mild axial loading, you get the simplest fx, a compression fx—like a simple long bone fx--worth 1 pt.

This is like when you just start to kneading the dough. There's pressure, but not as much as with a rolling pin! Image
Read 13 tweets
Mar 14
1/The 90s called & wants its carotid imaging back!

It’s been 30 years--why are you still just quoting NASCET?

Do you feel vulnerable when it comes to identifying plaque vulnerability?

Here’s a thread to help you identify high risk plaques with carotid plaque imaging Image
2/Everyone knows the NASCET criteria:

If the patient is symptomatic & the greatest stenosis from the plaque is >70% of the diameter of normal distal lumen, patient will likely benefit from carotid endarterectomy.

But that doesn’t mean the remaining patients are just fine! Image
3/Yes, carotid plaques resulting in high grade stenosis are high risk.

But assuming that stenosis is the only mechanism by which a carotid plaque is high risk is like assuming that the only way to kill someone is by strangulation. Image
Read 25 tweets

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