Lea Alhilali, MD

🔥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

Yes!! Great sign!!

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

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

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!

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!

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!

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!

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!

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!

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.

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.

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.

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!

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!

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!

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

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

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!

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!

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!

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

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!

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

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

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!!

🧑🏽‍🚀 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.

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!

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!!

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