Lea Alhilali, MD Profile picture
Mar 15, 2023 8 tweets 5 min read Read on X
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 Image
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. Image
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 Image
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 Image
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! 🤢 Image
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 Image
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 Image
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! Image

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More from @teachplaygrub

Jun 23
1/Do you get a Broca’s aphasia trying remember the location of Broca's area?

Does trying to remember inferior frontal gyrus anatomy leave you speechless?

Don't be at a loss for words when it comes to Broca's area

Here’s a 🧵to help you remember the anatomy of this key region! Image
2/Anatomy of the inferior frontal gyrus (IFG) is best seen on the sagittal images, where it looks like the McDonald’s arches.

So, to find this area on MR, I open the sagittal images & scroll until I see the arches. When it comes to this method of finding the IFG, i’m lovin it. Image
3/Inferior frontal gyrus also looks like a sideways 3, if you prefer. This 3 is helpful bc the inferior frontal gyrus has 3 parts—called pars Image
Read 13 tweets
Jun 19
1/Feeling intoxicated trying to remember all the findings in alcohol use disorder?!

Here’s something to put you in high spirits!

This month’s @Radiographics has the important neuroimaging findings alcohol use disorder!



@cookyscan1 @RadG_editor #RGphx pubs.rsna.org/doi/10.1148/rg…Image
2/There’s an easy rhyme to help you remember the important neuroimaging findings of alcohol use disorder

“Basal ganglia is white...”

Get intrinsic T1 shortening in the BG that makes it look white as a ghost! Image
3/Next “...Cortex is bright”

Acute hyperammonemic encephalopathy cause cortical restricted diffusion, especially the insula, so that it looks as bright as a light bulb! Image
Read 8 tweets
Jun 9
1/Need help reading spine imaging? I’ve got your back!

It’s as easy as ABC!

A thread about an easy mnemonic you can use on every single spine study you see to increase your speed & make sure you never miss a thing! Image
2/A is for alignment

Look for:
(1) Unstable injuries

(2) Malalignment that causes early degenerative change. Abnormal motion causes spinal elements to abnormally move against each other, like grinding teeth wears down teeth—this wears down the spine Image
3/B is for bones.

On CT, the most important thing to look for w/bones is fractures. You may see focal bony lesions, but you may not

On MR, it is the opposite—you can see marrow lesions easily but you may or may not see edema associated w/fractures if the fracture is subtle Image
Read 11 tweets
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

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