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Lea Alhilali, MD

@teachplaygrub

Mar 15, 2023 • 8 tweets • 5 min read • Read on X

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1/I call the skullbase “homebase” bc you can’t make an anatomy homerun without it!

Most know the arteries of the skullbase, but few know the veins. Do you?

Here’s a🧵to help you remember #skullbase venous #anatomy!
#medtwitter #meded #neurorad #radtwitter #neurosurgery #radres

2/When I look at the skullbase veins, I see an angry Santa yelling at me. His eyebrows are raised, his mouth is open, & he has a mustache w/a big beard hanging down.

Each I look at the skullbase, I look for this Santa—bc each part of him is an important venous structure.

3/So let’s start w/Santa’s eyes. The eyes are actually not a venous structure, but an important landmark—foramen ovale, where the V3 trigeminal nerve exit.

I remember ovale is Santa's eyes bc eyes are OVAL, so his eyes are OVALE

4/Next are Santa’s angry raised eyebrows. These are the sphenoparietal sinuses.

I remember these are the eyebrows bc I call them “seen”-oparietal sinuses & you see w/your eyes.

These have this “eyebrow” shape bc they are following the curve of the greater sphenoid wing

5/Sphenoparietal sinuses meet in the middle at the cavernous sinus—like your eyebrows meet in the middle at your nose.

I remember the cavernous sinus & intracavernous sinuses are Santa’s nose bc you dig in a cavern. And where do all kids like to go digging? Their nose! 🤢

6/Right below Santa’s nose is his mustache & this is the basilar plexus, right below the cavernous sinus.

You can remember this bc mustaches are made of a base & handlebars—and the BASE of Santa’s mustache is the BASilar plexus

7/Extending from Santa’s mustache is his beard. These are the petrosal sinuses (inferior & superior), important in many neurosurgical approaches.

You can remember that the PETROsal sinuses make up sides of the beard bc you use PETROleum to smooth the sides of your beard

8/Finally, Santa’s mouth is the marginal sinus. I remember this bc the word marginal sounds like “Aaaargh”—the sound pirates make from their mouth. I call it the Maaaargh—inal sinus

So hopefully this thread has given you some ELF-confidence when it comes to skullbase anatomy!

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More from @teachplaygrub

Lea Alhilali, MD

@teachplaygrub

Oct 29

1/To call it or not to call it? That is the question!

Feeling wacky & wobbly when it comes to normal pressure hydrocephalus?

Don’t want to overcall it, but don’t want to miss it either!

Check out the latest in NPH w/this month’s @theAJNR SCANtastic!

ajnr.org/content/45/10/…

2/NPH was first described in 1965—but, of the original 6 pts, 4 were found to have underlying causes for hydrocephalus.

This begs the question—when do you stop looking & call it idiopathic? When do you suggest it on imaging?

3/There’s an iNPH Radscale, which scores 7 different imaging features.

Score above 8 is very sensitive for iNPH.

But who’s going to take out calipers & evaluate SEVEN different imaging findings on every dementia MR?

Also this scale doesn’t predict who will respond to shunting

Read 14 tweets

Lea Alhilali, MD

@teachplaygrub

Oct 18

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.

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

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.

Read 20 tweets

Lea Alhilali, MD

@teachplaygrub

Oct 16

1/Time is brain!

So you don’t have time to struggle w/that stroke alert head CT.

If there’s no flow, what are the things you need to know??

Here’s a thread to help you with the five main CT findings in acute stroke.

2/CT in acute stroke has 2 main purposes—(1) exclude intracranial hemorrhage (a contraindication to thrombolysis) & (2) exclude other pathologies mimicking acute stroke.

However, that doesn’t mean you can’t see other findings that can help you diagnosis a stroke.

3/Infarct appearance depends on timing.

In first 12 hrs, the most common imaging finding is…a normal head CT.

However, in some, you see a hyperdense artery or basal ganglia obscuration.

Later in the acute period, you see loss of gray white differentiation & sulcal effacement

Read 13 tweets

Lea Alhilali, MD

@teachplaygrub

Oct 14

1/They say form follows function!

Brain MRI anatomy is best understood in terms of both form & function.

Here’s a short thread to help you to remember important functional brain anatomy--so you truly can clinically correlate!

2/Let’s start at the top. At the vertex is the superior frontal gyrus. This is easy to remember, bc it’s at the top—and being at the top is superior. It’s like the superior king at the top of the vertex.

3/It is also easy to recognize on imaging. It looks like a big thumb pointing straight up out of the brain. I always look for that thumbs up when I am looking for the superior frontal gyrus (SFG)

Read 12 tweets

Lea Alhilali, MD

@teachplaygrub

Oct 11

1/Radiologist not answering the phone?

Just want a quick read on that stat head CT?

Here's a little help on how to do it yourself w/a thread on how to read a head CT!

2/In bread & butter neuroimaging—CT is the bread—maybe a little bland, not super exciting—but necessary & you can get a lot of nutrition out of it

MRI is like the butter—everyone loves it, it makes everything better, & it packs a lot of calories. Today, we start w/the bread!

3/The most important thing to look for on a head CT is blood.

Blood is Bright on a head CT—both start w/B.

Blood is bright bc for all it’s Nobel prizes, all CT is is a density measurement—and blood is denser (thicker) than water & denser things are brighter on CT

Read 20 tweets

Lea Alhilali, MD

@teachplaygrub

Oct 4

1/Want to TRI to learn something new about the TRIGEMINAL nerve?

If you’re only looking at the skullbase, you are missing a significant part of the trigeminal nucleus!

Let my help you TRI to up your game when it comes to TRIGEMINAL anatomy

2/We normally think of the trigeminal nerve nucleus in the brainstem.

But the trigeminal nucleus actually extends into the spine like a ponytail called the spinal trigeminal nucleus.

3/It extends down to around C2 to C4

You can remember this because cranial nerve 5 doesn’t extend below C5!

Read 11 tweets

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