Just because you don’t see it, doesn’t mean it’s not there!!! Just because you don’t see all cranial nerves on MRI doesn’t mean they aren’t there! You must know their anatomy so you know when pathology might affect them. Here is a figure w/the anatomy you NEED to know! ➡️Just remember this easy rule of four from Peter Gates: There are: 🔸 4 cranial nerves from above the pons (including 2 from the midbrain) 🔸4 from the pons 🔸And 4 from the medulla oblongata! Now you won't have be nervous when it comes to this nerve anatomy!

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!!!

Time for you to meet your match!   T2/FLAIR mismatch sign in brain tumors can be very helpful.   But do you know how to use it?   Or do you go into a coma reading studies on gliomas?   Here’s what you need to know so you will never be overmatched when it comes to T2/FLAIR mismatch!   T2/FLAIR mismatch is when tumor is very bright on T2, but saturates on FLAIR imaging—usually centrally, w/a small remaining rim of bright signal.   It’s a very specific radiogenomic sign for an astrocytoma (IDH-mutant, 1p19q non-codeleted), as opposed to other low-grade gliomas   Here’s how to remember that: Astrocytoma Astro = astronomy.  T2/FLAIR mismatch looks like a black hole, dark centrally with a bright rim, like the event horizon Black holes are in ASTROnomy, T2/FLAIR mismatch is in ASTROcytomas   Oligodendroglioma Oligo sounds “Ah, I’ll go” I remember that in oligos the FLAIR will GO along with the T2 So FLAIR goes with T2 in oligos—so they look similar without mismatch   Why does this T2/FLAIR mismatch happen? Pathologically it seems to be from microcysts in astrocytomas that a very bright on T2 (because they are tiny fluid filled cysts) But these cysts saturate on FLAIR   Now you know how remember the T2/FLAIR mismatch sign!   Hopefully now you can catch every case of T2/FLAIR mismatch!   Time for you to meet your match!

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!