Lea Alhilali, MD
@teachplaygrub • 79,616 subscribers
Neuroradiologist @HRInstitute_AZ. @BarrowNeuro. Striving to make learning neuroimaging and anatomy fun. If I can make you laugh, I can make you learn.
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Here’s a head start on head CT anatomy!! Cisterns: think “CT loves clear space.” If it’s dark space around the brainstem, that’s a cistern. Suprasellar = the starfish, S is for star and Suprasellar! Ambient = hugging the midbrain. Remember Amb-brace cistern, it embraces the midbrain! Quadrigeminal = the smile behind it. Remember, you are GEM if you smile!! Lobes made easy: Frontal lobe = Get in FRONT of things = planning, personality, decisions. Parietal lobe = “pair-ietal” = pair of hands to feel things = sensation and spatial awareness. Temporal lobe = Remember conTEMPlation =memory. And remember tempo = hearing Occipital lobe = “optic-pital” in the back = vision. Hopefully this will help you wrap your head around CT head anatomy!!
Lea Alhilali, MD23,182 Aufrufe • vor 3 Monaten
If you aren’t cheating, you aren’t trying! Are you looking at MRIs? Feeling some confusion about the diffusion? Feel impaired when it comes to the FLAIR? Wish you could cheat a little? Here’s a little cheat sheet on all the sequences you NEED to know for looking at MRIs! ➡️T1: It’s for anatomy, so brain structures reflect the same color as real life. 🔸So gray matter is gray on T1 & white matter is white on T1. 🔸It’s also for contrast. Contrast is taken up by masses making them light up & easier to see. ➡️T2: It’s the water sensitive sequence. 🔸What is pathologic water in the brain? Edema! 🔸Remember--everything bad in this world is trying to turn you back into what you came from—water! ➡️DWI: Diffusion detects stroke, which are bright on DWI. 🔸But anything that makes space tight in the brain can be bright on diffusion (cellular masses, pus under pressure, etc.) ➡️Gradient: Gradient is sensitive to metals. 🔸What’s the most important metal in body? Iron—bc iron is in blood. 🔸So gradient is our blood sensitive sequence 🌟So remember🌟 ▶️T1 is for Anatomy & Contrast ▶️T2 is for Water & Edema ▶️DWI is for stroke ▶️Gradient is for blood Hopefully, this will help you next time you have an MRI--who says cheaters never win? 😉
Lea Alhilali, MD25,852 Aufrufe • vor 4 Monaten
Are you agile on the sagittals?? Sagittal T1 images are for anatomy, but only if you know how to use them! Here is how I remember the sagittal anatomy 1. Start lateral 2. Find the gyrus that looks like a triangle, that is the pars triangularis of the inferior frontal gyrus 3. In front of it is the pars orbitalis—easy it’s over the orbit 4. Behind it is the pars opercularis. Remember oper sounds like OVER so its OVER the sylvian fissure 5. Behind the pars opercularis is the precentral gyrus 6. Right behind the precentral is the post central—duh post follows pre! 7. Behind the post central is the supramarginal gyrus. Remember supra means above, so it’s above the sylvian fissure. Margin = at the posterior margin of the sylvian fissure 8. Behind the supramarginal gyrus is the inferior parietal lobule. Remember inferior is below supra, so inferior parietal lobule is below the supramarginal 9. More medial is the lateral orbital gyrus. It’s easy, it above the orbit! 10. Even more medial is the gyrus rectus. Rectus means straight, so if you see a gyrus that is straight like a line, that is the gyrus rectus! Hopefully this gives you a handle on the sagittal! Stay tuned for the midline sagittal anatomy!!
Lea Alhilali, MD22,493 Aufrufe • vor 4 Monaten
Is cranial nerve anatomy making you nervous??!! High resolution SSFP imaging can visualize cranial nerves, typically for pts w/microvascular compression But knowing their anatomy & location can help you on any imaging—bc if you know where they are, you know if they may be involved Here’s what you can see on MRI: Olfactory: along anterior cranial fossa above the cribriform plate Optic: from globe, posteriorly through the orbit until intracranially optic nerves join to form chiasm Oculomotor: from between the cerebral peduncles to cavernous sinus Trochlear: From back of the midbrain at the aqueduct to cavernous sinus Trigeminal: From pons at the middle cerebellar peduncles into meckels cave Abducens: From undersurface of inferior pons anteriorly to dorello canal along clivus 7th/8th complex: From undersurface of inferior pons laterally to the IAC Glossopharyngeal & vagus: from medulla where it looks like a clover to the jugular foramen Hypoglossal: from medulla where it looks round like the spinal cord to the Hypoglossal foramen Hopefully all this info of cranial nerves didn’t get on your last nerve!!
Lea Alhilali, MD39,906 Aufrufe • vor 1 Jahr
l've got your back — literally! A solid grasp of lumbar spine anatomy is essential to be able to find pathology and be accurate in reporting. You need to know where the nerve roots lie in the central canal and neural foramina to know when they are compressed. And you need to know your disc nomenclature to accurately describe the pathology This video shows you the anatomy and nomenclature you NEED to know! Because when your anatomy knowledge is weak, your reports can really be a pain in the back!
Lea Alhilali, MD34,414 Aufrufe • vor 1 Jahr
FREE RADIOLOGY LECTURE TODAY! In honor of the FREE MSK lecture I am hosting today to promote the Radiopaedia.org 2025 conference, here is MSK from a neurorad point of view!! Lecture is at 1pm EST! Or you can watch it on demand if you missed it!! Here is the link: And here is how to remember the paraspinous muscles: Psoas: Remember P is for Prevertebral, it is in front of the muscles Multifidus Remember M is for Medial so it is the most medial of the dorsal paraspinous muscles Erector Spinae: E is for External so it is the external dorsal paraspinous muscles Quadratus Lumborum: Q is for Quill and it sticks out from the spine like a Quill Feather Now you can remember the paraspinous muscles and hopefully you can join me today or on demand!!
Lea Alhilali, MD30,819 Aufrufe • vor 10 Monaten
Back by popular demand!! Sagittal T1 is meant for anatomy! Do you know it?? Most people know anatomy mainly in the axial plane. But the sagittal is actually perfect for anatomy Sagittal shows the midline structures & makes gyral anatomy easy, bc gyri in the brain are structured like a layer cake. And just how you see the layers in the cake best when it is cut on the side—you best see gyral anatomy when the brain is cut from the side. For every sagittal T1, I have certain check points I check as I move through the anatomy. This shows you my check points. How many do you know? How many do you have as you scroll?
Lea Alhilali, MD38,180 Aufrufe • vor 1 Jahr
Time to go with the flow! Knowing vascular anatomy is the first step to reading any angiogram These are the key vessels you need to know! Then I always remember to check for pathology using the mnemonic ANGIO to remind me what to look for: A = aneurysms, arteriovenous malformations N = Narrowing (atherosclerotic narrowing) G = Globules (globular or beaded appearance in vasculitis or RCVS) I = Irregularity/dissction O = Occlusion (large vessel occlusion for endovascular) So now you know the anatomy & pathology to look for angiographic studies! Remember, there are MANY numbering systems for the carotid. This is just one—so always say the name of the segment and not the number. You never know what numbering system the person reading it uses!!! Hopefully, now you will never have to circle back on a study of the circle of Willis!!
Lea Alhilali, MD28,381 Aufrufe • vor 9 Monaten
Are you blind when it comes to occipital anatomy? This is a forgotten region, b/c vision isn’t considered eloquent. But it is still important to remember the anatomy! Here’s how, starting at the bottom —Lateral occipital gyrus It down at the bottom in the occipital lobe & lateral—simple one there! —Lingual gyrus It’s at the bottom and in the center, just like your tongue (lingual) is in the center of your mouth —Visual cortex Looks like two evil snake like eyes, staring at you from either side. So if you see eyes, it’s the visual cortex! —Parietal lobules Remember, Lobule and Lateral both start with L, so the lobules are lateral & stacked on each other —Cuneus and precuneus Remever, C is for central, so precuneus and cuneus are central in the midline! Hopefully, this post will back you up when it comes to the back of the brain anatomy!!
Lea Alhilali, MD26,680 Aufrufe • vor 10 Monaten
Time to go with the flow! Knowing vascular anatomy is the first step to reading any angiogram These are the key vessels you need to know! Then I always remember to check for pathology using the mnemonic ANGIO to remind me what to look for: A = aneurysms, arteriovenous malformations N = Narrowing (atherosclerotic narrowing) G = Globules (globular or beaded appearance in vasculitis or RCVS) I = Irregularity/dissction O = Occlusion (large vessel occlusion for endovascular) So now you know the anatomy & pathology to look for angiographic studies! Hopefully, now you will never have to circle back on a study of the circle of Willis!!
Lea Alhilali, MD34,320 Aufrufe • vor 1 Jahr
My attending once said, “If you don’t want to miss something, you have to know where look for it!” Intracranial aneurysms may occur at many locations, but overwhelming at the ACOM & PCOMM. Look hard at these regions! Remember, you miss 100% of aneurysms you don't look for! Remember these two regions by always saying to yourself before you sign off any angiogram report: "Always Please Communicate Aneurysms!" Always = Anterior Please = Posterior Communicate = Communicating Hopefully this will rupture any misconceptions about where to look for aneurysms!
Lea Alhilali, MD32,217 Aufrufe • vor 1 Jahr
Need help reading spine imaging? I’ve got your back! It’s as easy as ABC! This post is 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! Just remember ABCD: A = Alignment (1) look for unstable injuries (2) look for malalignment that causes early degenerative change B = Bones On CT, look for fractures On MRI, look for marrow lesions/edema C = Cord/Canal On CT, look at the canal contents for large masses or collections On MRI, look for canal narrowing & cord edema D= Discs/Degenerative --Normal discs should look like a kidney on it’s side on axial images, w/tiny hilum/. Loss of this hilum means there a bulge --On sagittal images, normal discs should look like jelly donuts. If they look like pancakes instead of jelly donuts, they are degenerated Disc nomenclature: Bulge = gaining weight & loosening belt (annulus gets loose) Protrusion = hernia (annulus tears & disc protrudes through) Extrusion = disc becomes like toothpaste & squeezes around everywhere Free Fragment = like toothpaste on the toothbrush—completely separate from the disc Now you know how to approach spine imaging studies in a systematic way! Hopefully, now reading spine imaging won’t be such back breaking work!
Lea Alhilali, MD22,130 Aufrufe • vor 9 Monaten
Form follows function!! Do you know functional neuroanatomy? This post will help you to remember the functional neuroanatomy you need to function if you are reading brain MRIs! Here’s how: 1. First start at the top —At the top you will see a gyrus that looks like a thumbs sticking up. This is the superior frontal gyrus (SFG). —Remember this bc you get a thumbs up when you do a superior job! 2. Next to the SFG is the middle frontal gyrus —This looks like knuckles next your superior frontal gyrus thumb —Remember this bc your MIDDLE finger is in your knuckles —ALWAYS LOOK FOR THE KNUCKLES W/THE THUMBS UP! 3.Use the SFG to find the motor strip —SFG has a motor & language component —Motor component is first at the back (remember, you walk before you talk!) —Motor component of SFG crashes into the motor strip —Remember, when two cars crash, their MOTORS hit 4.Confirm its the motor strip by finding the hand omega —Hand motor region looks like an upside down omega —Remember Omega is a fancy watch brand you wear near your HAND! Hopefully now you will be eloquent when it comes to this eloquent cortex!!!
Lea Alhilali, MD22,614 Aufrufe • vor 9 Monaten
Wish you had a sixth sense to localize that sixth cranial nerve palsy? Feeling six feet under when you see a sixth nerve deficit? Here’s a cheat sheet to help you locate the lesion in a sixth cranial nerve palsy! Just remember the Six Syndromes of the Sixth Cranial Nerve! There are six syndromes of CN6—one for each of its five stops along the way to its destination in the orbit—and one that is idiopathic 1. Brainstem 🔸CN6 nucleus is at the facial colliculus—looks like a baby’s butt of the brainstem 🔸Many important structures here 🔸Rarely get an isolated palsy & uniquely can get associated MOTOR deficits 2. Subarachnoid space 🔸CN6 exits under the dad bod belly of the pons & enters Dorello canal 🔸Susceptible to changes in intracranial pressure—can get stretched! 🔸ICP changes can cause BILATERAL palsies here 3. Petrous apex 🔸Exits Dorello canal & travels under the petroclinoid ligament, like under a seat belt 🔸Many other nerves here 🔸Rarely get an isolated palsy & uniquely can get associated HEARING deficit 4. Cavernous sinus 🔸Many nerves in close proximity! 🔸Rare to get an isolated palsy 🔸Many pathologies can affect the cavernous sinus—so many differentials & many deficits! 5. Orbit 🔸Short orbital course—quick lateral turn after the superior orbital fissure to innervate the lateral rectus 🔸Rare to have isolated palsy 🔸Get a SOF syndrome or orbital apex syndrome 6. Idiopathic 🔸No other identifiable etiology 🔸Like transverse myelitis—likely microvascular or post-inflammatory 🔸1/4th of CN6 palsies are idiopathic But you must exclude the other five first! Now you know the Six Syndromes of the Sixth Cranial Nerve. Hopefully now when you see a CN6 palsy, there will never be six degrees of separation between you & the etiology!
Lea Alhilali, MD43,523 Aufrufe • vor 2 Jahren
Here’s how to make hippocampal anatomy memorable! This video shows hippocampal anatomy that you need to stay in your hippocampus! --Body is where you can see the spiraling line that is the Cornu Ammonis. --Cornu Ammonis spirals into the dentate nucleus so that they look like a yin-yang. The theme of hippocampal anatomy is the spiral—on every single hippocampal MRI, you should look for that T2 dark line of the Cornu Ammonis or SLRM, spiraling into the dentate to make a yin yang! If this is lost, that is an early sign of MTS. This month’s @rsnagram RadioGraphics has all you need to know about epilepsy, how we image it & how we treat it! Check it out: So now you know the basics of hippocampal anatomy—may you never forget the hippocampal spiral! Cooky Menias RadioGraphics RadioGraphics_Editor
Lea Alhilali, MD22,632 Aufrufe • vor 10 Monaten
FREE sinus lecture today!! In honor of the FREE sinus lecture I am giving today to promote the Radiopaedia.org 2025 conference, here is a little sample of sinus anatomy!! Lecture is today at 2pm EST!! Here is the link Honestly, I get more engagement from my sinus lectures than I do from my brain lectures!! Everyone has to read them but no one really teaches them! If you are watching this after June 13, 2025 you can still watch it on demand at the Radiopaedia YouTube channel!
Lea Alhilali, MD24,019 Aufrufe • vor 11 Monaten
Have some mild cognitive impairment trying to remember dementia patterns on imaging? Is looking at dementia PET scans one of your PET peeves? Have short-term memory loss when you read about dementia imaging? Here's a way to remember dementia patterns so you will never forget! Major dementia imaging patterns: Alzheimer's disease (AD) · AD has a Nike swoosh pattern-with decreased metabolism in parietal & temporal regions · Remember when you see the Nike swoosh patter, just call it! Dementia w/Lewy Bodies (DLB) · Temporoparietal hypometabolism like AD but also involves occipital cortex, specific for DLB. · DLB also extends farther to the ant. temporal cortex. · Remember, regions of hypometabolism look more like an L. And Lewy starts w/an L Frontotemporal Dementia (FTD) · Frontal & temporal hypometabolism as expected, but extends along the anterior cingulate gyrus · Anterior cingulate involvement makes the hypometabolism looks like a lowercase letter f-and frontotemporal starts with f Posterior cortical atrophy · Can be from AD or DLB & has hypometabolism in the occipital & post. temporal lobe, sparing the anterior temporal lobe · Sparing the anterior temporal lobe makes the involvement look like a C instead of an L like DLB. · So remember pCa Vascular dementia · Vascular dementia has a variable distribution, depending on the regions infarcted (V is both for Vascular & Variable) · Wedged shaped regions of hypometabolism corresponding to cortical infarcts-looks like an inverted V This list isn't all inclusive & there can be variations or even mixed dementias But hopefully this gives you a starting point you won't soon forget!
Lea Alhilali, MD19,286 Aufrufe • vor 9 Monaten
Time to master mass effect!! Four main types of herniation from mass effect: Subfalcine: Brain herniates under the flax. See as midline shift in axial CT slices Transtentorial: Temporal lobes herniated across the tentorium into the posterior fossa & cause mass effect upon the brainstem. This is seen as effacement of basilar cisterns on axial CT slices Transcranial: Occurs in the setting of a defect-usually to relieve mass effect. Brain herniates into the defect, usually relieving mass effect intracranially Tonsillar herniation: Mass effect in the posterior fossa causes the brainstem to herniate downward through the foramen magnum. This can eventually compress the brainstem. Now you know the different types of brain herniations and what they look like! Hopefully, now you will never have to debate when the brain herniates!!
Lea Alhilali, MD18,642 Aufrufe • vor 10 Monaten
When Radiopaedia.org calls, you answer! There is nothing I hate more than being on camera! But I’ll do it for #Radiopaedia2024! If you like me on X, you'll LOVE this conference! I don’t do many conferences and I am almost never on camera, but this is an opportunity I couldn’t miss! Register now: It's proudly free in 125 low & middle income countries & I'm proud to be a part of it!
Lea Alhilali, MD27,966 Aufrufe • vor 1 Jahr
Are you right when it’s bright? Bright cortical signal on diffusion images is classically associated w/hypoxic-ischemic injury. But there are many mimics! Do you know how to recognize the different patterns of cortical restricted diffusion? Here’s a figure & some pearls to help! Cortical restricted diffusion many seen in a variety of conditions—many with VERY different pathophysiology & prognosis. There are 6 main patterns: (1) Cortex & deep gray (2) Diffuse Cortex (3) Focal Cortex (4) Limbic (5) Deep gray (6) White matter Here are some steps to help differentiate: (1) Is the presentation acute or chronic? (2) If it’s acute, toxic-metabolic & hypoxic-ischemic events account for the majority of cases. Seizure & encephalitis are less frequent and typically more focal (3) In the chronic setting, isolated cortical involvement is almost diagnostic of CJD Hopefully, this will clear up any confusion about the diffusion!
Lea Alhilali, MD18,438 Aufrufe • vor 1 Jahr