Lea Alhilali, MD Profile picture
Jan 14, 2023 12 tweets 7 min read Read on X
1/Is your ability to remember temporal lobe anatomy seem, well, temporary?

Here’s a #tweetorial to help you remember the structures of the temporal lobe!

#medtwitter #meded #neurotwitter #radtwitter #radres #neurorad #FOAMed #neurosurgery #medstudenttwitter #neurology
2/Temporal lobe can be divided centrally & peripherally. Centrally is the hippocampus. It’s a very old part of the brain & is relatively well preserved going all the way back to rats. Its main function is memory—getting both rats & us through mazes—including the maze of life
3/Peripherally is the neocortex. Although rats also have neocortex, theirs is much different structurally than humans.

So I like to think of neocortex as providing the newer (neo) functions of the temporal lobes seen in humans: speech, language, visual processing/social cues
4/So let’s start w/the oldest part of the temporal lobe, the hippocampus, and we will move clockwise from there.
5/Next to the hippocampus is the parahippocampal gyrus. I remember this b/c the hippocampus is the oldest part of the temporal lobe & older folks love to go in pairs. So this is the PAIR-ahippocampal gyrus—it pairs w/the old hippocampus
6/Next to the parahippocampal gyrus is the fusiform gyrus. I remember this b/c this gyrus bridges (some might say FUSES) the older, allocortex part of the temporal lobe (hippocampus/parahippocampal) w/the newer, neocortical structures. Fusiform gyrus is the neocortical bridge
7/Fusiform gyrus bridges the older temporal lobe w/the new lateral temporal neocortex.

I think the lateral neocortex looks like a parfait—w/the superior, middle, & inferior temporal gyri layered on top of the fusiform gyrus. Heschl’s transverse gyrus forms the strawberry on top
8/You can remember that the fusiform gyrus is at the bottom of this parfait b/c fusiform means elongated—and the stem of a parfait glass is elongated—almost fusiform!
9/You can remember that Heschl’s gyrus is the fruit on top b/c Heschl sounds like Bushel, and fruit to put on top comes in Bushels!
10/You can also see this parfait in the coronal plane, although it is a little tilted!
11/Last temporal lobe structure is the temporal stem. It is the white matter connecting the gyri of the temporal lobe to the rest of the brain. I remember this b/c I think the temporal lobe looks like an upside-down cauliflower—& the STEM of that cauliflower is the temporal STEM
12/So now you can remember the anatomy of the temporal lobe:

An old couple

A bridge fusing them to the next generation

A delicious parfait

All connected by a cauliflower stem.

I hope this new anatomy knowledge will be anything but temporary!

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More from @teachplaygrub

Jun 6
1/Raise your hand if you’re confused by the BRACHIAL PLEXUS!

I could never seem to remember or understand it—but now I do & I’ll show you how!

A thread so you will never fear brachial plexus anatomy again! Image
2/Everyone has a mnemonic to remember brachial plexus anatomy.

I’m a radiologist, so I remember one about Rad Techs.

But just remembering the names & their order isn’t enough.

That is just the starting point--let’s really understand it Image
3/From the mnemonic, we start with the roots—the cervical nerve roots.

I remember which roots make up the brachial plexus by remembering that it supplies the hand.

You have 5 fingers on your hand so we start with C5 & we take 5 nerve roots (C5-T1). Image
Read 20 tweets
Jun 4
1/Having trouble remembering what to look for in vascular dementia on imaging?

Almost everyone w/memory loss has infarcts. Which are important?

The latest @theajnr SCANtastic has what you need to know:

ajnr.org/content/46/5/1…Image
@TheAJNR 2/Vascular cognitive impairment, or its most serious form, vascular dementia, used to be called multi-infarct dementia.

It was thought dementia directly resulted from brain volume loss from infarcts, w/the thought that 50-100cc of infarcted related volume loss caused dementia Image
@TheAJNR 3/But that’s now outdated. We now know vascular dementia results from diverse pathologies that all share a common vascular origin.

It’s possible to lose little volume from infarct & still result in dementia.

So if infarcts are common—which contribute to vascular dementia? Image
Read 20 tweets
Jun 2
1/Having trouble remembering how to differentiate dementias on imaging?

Is looking at dementia PET scans one of your PET peeves?

Here’s a thread to show you how to remember the imaging findings in dementia & never forget! Image
2/The most common functional imaging used in dementia is FDG PET. And the most common dementia is Alzheimer’s disease (AD).

On PET, AD demonstrates a typical Nike swoosh pattern—with decreased metabolism in the parietal & temporal regions Image
3/The swoosh rapidly tapers anteriorly—& so does hypometabolism in AD in the temporal lobe. It usually spares the anterior temporal poles.

So in AD look for a rapidly tapering Nike swoosh, w/hypometabolism in the parietal/temporal regions—sparing the anterior temporal pole Image
Read 16 tweets
May 27
1/Feel perplexed by the lumbosacral plexus??

This plexus doesn’t have to be so complex-us

Here’s what you need to know from this month’s @Radiographics!



@cookyscan1 @RadG_editor doi.org/10.1148/rg.240…Image
@RadioGraphics @cookyscan1 @RadG_Editor 2/The lumbosacral plexus is like a love story

The lumbar & sacral plexuses met & fell in love

They loved each other so much they came together to create the nerves to the lower extremities! Image
@RadioGraphics @cookyscan1 @RadG_Editor 3/Lumbosacral plexus is essentially formed by the nerves from L1-S4 (with some other small contributions)

Remember this bc the plexus is to the lower extremitieis and L & 1 look legs and S & 4 look like feet! Image
Read 12 tweets
May 6
1/Have disagreements between radiologists on the degree of cervical canal stenosis become a pain in the neck?

Worried about sticking your neck out & calling severe cervical stenosis?

This month’s @theAJNR SCANtastic has the latest about Cspine MRI!

ajnr.org/content/46/4/7…Image
@TheAJNR 2/In the lumbar spine, it is all about the degree of canal narrowing & room for nerve roots.

In the cervical spine, we have another factor to think about—the cord.

Cord integrity is key. No matter the degree of stenosis, if the cord isn’t happy, the patient won’t be either Image
@TheAJNR 3/Cord flattening, even w/o canal stenosis, can cause myelopathy.

No one is quite sure why.

Some say it’s b/c mass effect on static imaging may be much worse dynamically, some say repetitive microtrauma, & some say micro-ischemia from compression of perforators Image
Read 16 tweets
May 2
1/Do radiologists sound like they are speaking a different language when they talk about MRI?

T1 shortening what? T2 prolongation who?

Here’s a translation w/an introductory thread to MRI. Image
2/Let’s start w/T1—it is #1 after all! T1 is for anatomy

Since it’s anatomic, brain structures will reflect the same color as real life

So gray matter is gray on T1 & white matter is white on T1

So if you see an image where gray is gray & white is white—you know it’s a T1 Image
3/T1 is also for contrast

Contrast material helps us to see masses

Contrast can’t get into normal brain & spine bc of the blood brain barrier—but masses don’t have a blood brain barrier, so when you give contrast, masses will take it up & light up, making them easier to see. Image
Read 20 tweets

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