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

May 29
1/Waving the white flag when it comes to white matter anatomy?

Turns out white matter anatomy isn’t black & white!

This months @theAJNR SCANtastic is the white knight you need to rescue you!

Here’s the white matter anatomy you NEED to know!

ajnr.org/content/45/5/5…
Image
2/Gray matter or cortical functional anatomy is well known.

Everyone knows the motor & sensory strips. Most know Broca’s & Wernicke’s

But most forget that white matter has similar functional topography & just bc it’s white matter doesn’t mean it doesn’t have function! Image
3/But too often we don’t refer to this white matter functional anatomy.

Instead we use general terms like “corona radiata”

But that’s the equivalent of using the word “body.”

Just like the body has many different systems in it, so does the corona radiata! Image
Read 12 tweets
May 21
1/Having trouble remembering what you should look for in vascular dementia on imaging?

Almost everyone worked up for dementia has infarcts. Which ones are important?

Here’s a thread on the key findings in vascular dementia! Image
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
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 21 tweets
May 20
1/Correlate clinically!

It’s harder than you think in THALAMUS—where its size is small & but the clinical symptoms are large.

Here’s a thread to help you remember the main thalamic syndromes & their locations! Image
2/Thalamus is a dense network of nuclei & tracts connected to almost everything in the brain. So almost any symptom can be correlated to it.

So saying “thalamus” as the answer when asked where a lesion is located is always reasonable—even w/o knowing what the symptoms are! Image
3/Think of the thalamus like the internet service provider or ISP for the brain.

Like an ISP, everywhere is connected through it. And like an ISP, things go bad when it goes down.

But just like an ISP, the problems created depend on where in the network the outage is located. Image
Read 23 tweets
May 17
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! Image
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. Image
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. Image
Read 25 tweets
May 14
1/Got the diagnosis when it comes to vessel stenosis?

Or is your knowledge narrow when it comes to vessel narrowing?

When it comes to vasospasm, do you know why it happens or what to look for?

Here is the thread you NEED to unravel why vessels twist up! Image
2/Vasospasm results from subarachnoid hemorrhage (SAH) & a buildup of multiple factors

It’s like how you can handle 1 nag from your boss on Monday—but after nagging all week, you break down on Friday!

Same w/vasospasm—it doesn’t happen until the end of the week after SAH! Image
3/So what is nagging that causes the vessel to shut down?

When the body breaks down blood from SAH, it releases free heme

And this free heme causes a cascade of negative consequences, call heme-related inflammation

So free heme is the annoying boss! Image
Read 21 tweets
May 13
1/ “Now listen carefully!”

Everyone has so much fear about the anatomy where they hear!

Do you dread temporal bone anatomy?

Do find the understanding ossicles impossible?

Do you know the ice cream cone sign on CT & then nada?

Then you need this thread on ossicular anatomy! Image
2/For the middle ear, I have a rule of 3s.

Middle ear is divided into 3 parts & it contains 3 ossicles.

Today we will focus on the ossicles—each of which has 3 parts! Image
3/First ossicle you meet when you enter the middle ear is the malleus.

It’s called the malleus because it acts like a mallet that hits a drum—literally—the ear drum!

I think it looks like Dr. Evil’s mini me, with its short body and round bald head Image
Read 19 tweets

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