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Lea Alhilali, MD

Jan 14 • 12 tweets • 7 min read

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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Lea Alhilali, MD

@teachplaygrub

Jan 10

1/Talk about twisting your back! Do spine vascular lesions make your brain feel tangled like the dilated vessels you see?

Here’s a #tweetorial on #spine vascular #anatomy & dural arteriovenous fistulas (dAVF)

#medtwitter #meded #FOAMed #neurotwitter #neurosurgery #neurorad

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

The spine is LONG—to get blood from the top of the cord 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.

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Lea Alhilali, MD

@teachplaygrub

Jan 5

1/Nothing strikes fear into the heart of a radiologist like the question,“Is it safe to do an MRI on this pt w/an implanted device?”

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2/MRI & CT are like nuclear & coal power, respectively. Everyone knows CT is worse for you & usually MRI is very safe & better for your body

But like nuclear power, when things go bad in MRI, they can go horribly wrong. Flying chairs into the magnet wrong. So, people are afraid

3/The trouble is from the magnetic attractive forces. There are 3 ways these attractions can wreak havoc. First is translation. Magnet literally pulls an object, like a chair, towards itself. This is the strongest attraction—like two lovers who literally can’t stay apart.

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Lea Alhilali, MD

@teachplaygrub

Dec 19, 2022

1/My hardest #tweetorial yet! Are you up for the challenge?

How stroke perfusion imaging works!

Ever wonder why it’s Tmax & not Tmin? Do you not question & let RAPID read the perfusion for you? Not anymore!
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2/Perfusion imaging is based on one principle: When you inject CT or MR intravenous contrast, the contrast flows w/blood & so contrast can be a surrogate marker for blood. This is key, b/c we can track contrast—it changes CT density or MR signal so we can see where it goes

3/So if we can track how contrast gets to the tissue (by changes in CT density or MR signal), then we can approximate how BLOOD is getting to the tissue. And how much blood is getting to the tissue is what perfusion imaging is all about.

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Lea Alhilali, MD

@teachplaygrub

Dec 12, 2022

1/”I LOVE spinal cord syndromes!” is a phrase that has NEVER, EVER been said by anyone.
Never fear—here is a #tweetorial on all the incomplete #spinalcord syndromes!
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2/Spinal cord anatomy can be complex. On imaging, we can see the ant & post nerve roots. We can also see the gray & white matter. Hidden w/in the white matter, however, are numerous efferent & afferent tracts—enough to make your head spin.

3/Lucky for you, for the incomplete cord syndromes, all you need to know is gray matter & 3 main tracts. Anterolaterally, spinothalamic tract (pain & temp). Posteriorly, dorsal columns (vibration, proprioception, & light touch), & next to it, corticospinal tracts—providing motor

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Lea Alhilali, MD

@teachplaygrub

Dec 7, 2022

1/Have disagreements between radiologists on the degree of cervical canal stenosis become a pain in the neck?!
Here’s a #tweetorial on cervical stenosis grading that’s easy, reproducible & evidence based
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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

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 in dynamic positions, some say it’s repetitive microtrauma, & some say micro-ischemia from compression of perforators

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Lea Alhilali, MD

@teachplaygrub

Nov 28, 2022

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 #tweetorial on how to date blood on MRI
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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. So let’s look at T1

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