iiinova — where your digital self keeps evolving

Reposted by Lea Alhilali, MD

Jim Siegler, Husband, Dad, MD, FAHA @jimsieglermd.bsky.social · 05/02/2025

🔥Chinese RCT shows PCSK9i in severe ICAD can reduce plaque thickness and luminal stenosis! (No surprise, but will be useful to justify this tx for our high risk patients!!) @ahascience.bsky.social #ISC25 @teachplaygrub.bsky.social @ericajonesmd.bsky.social @strokeupmc.bsky.social

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Lea Alhilali, MD @teachplaygrub.bsky.social · 23/01/2025

Are you right when it’s bright? Bright cortex on DWI is classically anoxic injury But mimics exist! 6 patterns -Cortex+deep gray -Diffuse Cortex -Focal Cortex -Limbic -Deep gray -WM Ask 3 ?’s: -Acute or chronic? -Acute=metabolic & anoxic. Sz & encephalitis rarer & focal -Chronic, think CJD

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Lea Alhilali, MD @teachplaygrub.bsky.social · 23/01/2025

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Lea Alhilali, MD @teachplaygrub.bsky.social · 21/01/2025

1/Have you been cutting corners when it comes to coronal anatomy? Do you just say a lesion is in the inferior frontal region & hope no one asks for details? It’s time to turn the corner on coronal anatomy Open this thread for an easy way to remember this frontal anatomy you need to know!

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Lea Alhilali, MD @teachplaygrub.bsky.social · 21/01/2025

3/ 3. Inferior, middle, and superior frontal gyri are arranged like a hand fan in the coronal plane above the gyrus rectus & orbital gyrus Now when it comes to coronal anatomy, hopefully you’ve cornered the market!

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Lea Alhilali, MD @teachplaygrub.bsky.social · 21/01/2025

2/ Only 3 things to remember:  1. Gyrus Rectus is above the nose. Remember this bc gyrus rectus means straight & it’s straight like your nose is straight! 2. Lateral orbital gyrus is along the medial roof of the, well, as expected, orbit!

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Lea Alhilali, MD @teachplaygrub.bsky.social · 21/01/2025

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Lea Alhilali, MD @teachplaygrub.bsky.social · 16/01/2025

1/ “Tell me where it hurts” How back pain radiates can tell you where a lesion is—if you know where to look! Do YOU know where to look? Open this thread to see how to remember lumbar radicular pain distributions! And keep this cheat sheet as a BACKUP for when you are dealing w/back pain!

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Lea Alhilali, MD @teachplaygrub.bsky.social · 16/01/2025

5/ So now you know where in the lumbar spine to a look when a patient tells you the pain radiates down their leg! Remember, there are many variations & this is just a starting guide But hopefully now remembering the lumbar radicular distributions won’t be a pain in the backside!

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Lea Alhilali, MD @teachplaygrub.bsky.social · 16/01/2025

4/ L5 L5 radiates to the big toe. Remember the little rhyme “Five is to the big guy!” L5 is also foot drop. Remember big guys are heavy, and heavy gravity = drop. S1 S1 radiates to the side of the foot. Remember this because both S1 and Side start w/S.

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Lea Alhilali, MD @teachplaygrub.bsky.social · 16/01/2025

3/ L3 L3 radiates to the knee Remember L3 is to the knee—easy, it rhymes! L4 L4 radiates to the calf. Remember this bc the number 4 looks like the calf, Top part of the 4 looking like a bulging gastroc & the bottom part of the four is the rest of the calf connecting to the ankle.

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Lea Alhilali, MD @teachplaygrub.bsky.social · 16/01/2025

2/ L1 L1 radiates to the groin Remember that b/c the number 1 is, well, um…phallic. So phallic number 1 radiates to the groin L2 L2 radiates to thigh Two is the number between 1 & 3, so distribution of L2 is between the distributions of L1 and L3—& between the groin (L1) & knee (L3) is the thigh.

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Lea Alhilali, MD @teachplaygrub.bsky.social · 16/01/2025

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Lea Alhilali, MD @teachplaygrub.bsky.social · 13/01/2025

1/Sink or swim! Brain is swimming in CSF! CSF is key for protection, buoyancy, & hormone/waste transport Most know basic ventricular anatomy, but not subarachnoid anatomy How many cisterns do YOU know? Open this thread for a quick guide to the key midline cisterns & what to know for each!

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Lea Alhilali, MD @teachplaygrub.bsky.social · 13/01/2025

4/ Quadrigeminal cistern Contains CN4 & pineal gland Remember bc QUAD is the prefix for FOUR Lamina terminalis: Contains ACOMM Remember this bc shape of SAH after ACOMM rupture follows this cistern anteriorly Now when you look at cisternal anatomy, you’ll definitely be able to go w/the flow!

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Lea Alhilali, MD @teachplaygrub.bsky.social · 13/01/2025

3/ Chiasmatic cistern Contains CN 2 & pituitary stalk Easy to remember bc CHIASM is CN 2 Interpeduncular cistern: Contains CN 3 & mammillary bodies Remember this bc if you lay the number 3 on its side it looks both like the 2 cerebral peduncles (where this cistern lies) & well, 2 mamillary bodies

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Lea Alhilali, MD @teachplaygrub.bsky.social · 13/01/2025

2/ Cisterna Magna: Largest cistern Contains CN 9-11 & vertebrals Remember: LARGEST cistern contains the LARGEST cranial nerve (vagus) & the 2 CN around it Prepontine cistern: Contains CN 6 & basilar Remember this bc the number 6 shape mirrors the anterior pons curvature, where this cistern lies

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Lea Alhilali, MD @teachplaygrub.bsky.social · 13/01/2025

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Reposted by Lea Alhilali, MD

Lea Alhilali, MD @teachplaygrub.bsky.social · 10/01/2025

1/Just because it’s called SMALL vessel disease doesn’t mean it doesn’t have a BIG impact! Small vessel disease (SVD) is a BIG contributor to vascular dementia, along w/large vessel cortical infarcts Do YOU know all the faces of small vessel disease? Open the thread for what you need to know!

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Lea Alhilali, MD @teachplaygrub.bsky.social · 10/01/2025

3/ Variability exists because of: --Perilesional penumbra --Remote effects from disruption of brain connectivity --Differing brain reserve & compensatory mechanisms So remember, imaging findings of SMALL vessel disease are just the tip of a very BIG iceberg!

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Lea Alhilali, MD @teachplaygrub.bsky.social · 10/01/2025

2/ Common imaging markers of SVD: --White matter hyperintensities (WMHs) --Lacunes --Enlarged perivascular spaces --Microbleeds --Small subcortical infarcts --Brain atrophy But what you see isn’t always what you get! Even in pts w/similar degrees of SVD, clinical symptoms can be very variable

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Lea Alhilali, MD @teachplaygrub.bsky.social · 10/01/2025

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Reposted by Lea Alhilali, MD

Lea Alhilali, MD @teachplaygrub.bsky.social · 09/01/2025

Is looking at dementia PETs one of your PET peeves? Main patterns 🔹AD Nike swoosh—if you see it, just call it! 🔹DLB Hypometabolism looks like an L. L=Lewy 🔹FTD Ant cingulate role makes an f. f=ftd 🔹Posterior cortical atrophy Anterior temporal sparing makes a C=pCa 🔹Vascular dementia Wedge shaped Vs

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Lea Alhilali, MD @teachplaygrub.bsky.social · 09/01/2025

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Reposted by Lea Alhilali, MD

Lea Alhilali, MD @teachplaygrub.bsky.social · 08/01/2025

Can you only remember temporal anatomy temporarily? It looks like a parfait! Heschl’s is strawberry on top 🔸Heschl sounds like bushel—& bushels=fruit Parfait layers=sup, mid, & inf gyri Glass stem is fusiform gyrus 🔸Stem has fusiform shape! Now your understanding will be, well, parfait!!

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Reposted by Lea Alhilali, MD

Radiopaedia @radiopaedia.org · 08/01/2025

🧑🏽‍🚀 Want to be a part of our virtual conference, #Radiopaedia2025? 👩🏼‍🚀 Submit your educational radiology poster; accepted rPosters will appear during the virtual conference and receive a certificate, a DOI citation and the chance to win an award! Deadline to submit your abstracts is 9th March 2025.

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Reposted by Lea Alhilali, MD

Lea Alhilali, MD @teachplaygrub.bsky.social · 06/01/2025

Does trying to figure out aphasia leave you speechless? At a loss for words for aphasia types? Remember 3 ?'s: 1. Fluency? Nonfluency=FRONTAL, ant. to fissure of Rolando 2. Comprehension? Impaired=TEMPOROPARIETAL 3. Repetition? Impaired=core PERISYLVIAN Answers give aphasia type & location!

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Lea Alhilali, MD @teachplaygrub.bsky.social · 08/01/2025

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Lea Alhilali, MD @teachplaygrub.bsky.social · 03/01/2025

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Lea Alhilali, MD @teachplaygrub.bsky.social · 30/12/2024

1/ How durable is your knowledge of dural lesions? How’s your knowledge base of the skull base? Know the difference between petroclival & petrous face? Middle fossa & middle sphenoid wing? Clinoid & clivus? Here is a map of the names of skull base meningiomas. How many do you know?

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Lea Alhilali, MD @teachplaygrub.bsky.social · 06/01/2025

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Lea Alhilali, MD @teachplaygrub.bsky.social · 03/01/2025

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Lea Alhilali, MD @teachplaygrub.bsky.social · 01/01/2025

It literally took my radiologist husband a full minute to figure out what was wrong about this picture! How long will it take YOU?? And can you spot the abnormality? Here’s to a year of high resolutions—both in imaging and for New Year’s! Wishing you all the best in 2025!

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Lea Alhilali, MD @teachplaygrub.bsky.social · 01/01/2025

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Reposted by Lea Alhilali, MD

Lea Alhilali, MD @teachplaygrub.bsky.social · 31/12/2024

Can’t metabolize all the metabolic bone diseases? When you see weird bones, do you just say, “suggestive of metabolic bone disease” & hope no one ask questions? Metabolic disease are complex but a few are a slam dunk Bookmark this figure for the 4 classic xray patterns you NEED to know!

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Lea Alhilali, MD @teachplaygrub.bsky.social · 31/12/2024

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Reposted by Lea Alhilali, MD

Lea Alhilali, MD @teachplaygrub.bsky.social · 27/12/2024

1/Knowing spinal arterial anatomy is a given. Knowing spinal venous anatomy is next level Vertebral venous plexus can be both good & evil--good for collaterals, bad for tumor spread, infxn, & emboli...and spinal CSF fistulas! Here’s the anatomy you MUST know if you are doing spine

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Lea Alhilali, MD @teachplaygrub.bsky.social · 30/12/2024

3/ I think of a cone coming up from the foramen magnum encompassing these lesions that I call the “cone of risk”! Hopefully, this anatomy of skull base dural lesions with stay with you for the duration!

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Lea Alhilali, MD @teachplaygrub.bsky.social · 30/12/2024

2/ Recognizing a lesion is only the 1st step. Communication is the next step. If you can’t describe lesion location, you haven’t done your job. For skull base meningiomas, high risk lesions are the medial lesions: Clinoid Cavernous sinus Tuberculum sellas Medial/incisural tentorium Clivus

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Lea Alhilali, MD @teachplaygrub.bsky.social · 30/12/2024

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Lea Alhilali, MD @teachplaygrub.bsky.social · 27/12/2024

3/ 🌟Internal plexus connects the anterior & posterior plexuses via foraminal veins along the nerve root These foraminal veins or foraminal plexus are site of CSF venous fistulas & the target for transvenous embolization! So it's important to learn this anatomy, no matter how draining it can be!

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Lea Alhilali, MD @teachplaygrub.bsky.social · 27/12/2024

2/ 3 rings: internal, anterior & posterior plexus ➡️Internal is the epidural plexus. It drains the basivertebral veins from the vertebral body ➡️Anterior drains the basivertebral veins and foraminal veins. ➡️Posterior drains the veins from the deep paraspinous musculature.

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Lea Alhilali, MD @teachplaygrub.bsky.social · 27/12/2024

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Lea Alhilali, MD @teachplaygrub.bsky.social · 26/12/2024

Wish that your knowledge of autoimmune encephalitis was automatic? Do you feel in limbo when it comes to the causes of limbic encephalitis? Do you know the causes? Or the other patterns of autoimmune encephalitis? Here’s a short video and some hints to help you figure it all out!

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Reposted by Lea Alhilali, MD

Lea Alhilali, MD @teachplaygrub.bsky.social · 25/12/2024

1/Season’s Greetings & Happy Arteries! Have you ever noticed how the cerebral arteries branch just like the antlers of a deer? Coincidence? Or is there a reason? Have you ever wondered why? What could drive 2 things so different to look so alike? Answer may surprise you!!

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Lea Alhilali, MD @teachplaygrub.bsky.social · 26/12/2024

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Lea Alhilali, MD @teachplaygrub.bsky.social · 26/12/2024

2/ Frontal: For large midline anterior and sometimes middle skull base lesions Temporal: For middle cranial fossa lesions, including intra-axial lesions in the mesial temporal lobe  Parietal: For mid to posterior cerebral hemisphere lesions while sparing the motor and sensory cortices.

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Lea Alhilali, MD @teachplaygrub.bsky.social · 25/12/2024

4/ —Decreased arterial fractal branching is marker of pathology—typically small vessel disease! So this holiday season, remember, when it comes arteries, fractals are what let it flow, let it flow, let it flow!

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Lea Alhilali, MD @teachplaygrub.bsky.social · 25/12/2024

3/ Answer: It depends on the situation. —For deer antlers: (1) Fractals allow the most tips to be exposed, good for attacking/fighting (2) Complex branching diverges energy away from the deer’s head—also helpful in a fight! —For arteries: Fractals are the most optimal to transport fluids.

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