Is trying to remember toxic encephalopathy patterns making you toxic? Does memorizing metabolic encephalopathy patterns put you into a metabolic coma? Don't become encephalopathic! Here is the cheat sheet of the encephalopathy patterns you NEED to know & how to remember them! ➡️Corpus Callosum: 🔸Lesions here are called cytotoxic lesions of the corpus callosum or CLOCC. 🔸Usually transient from cytotoxicity, especially viral infections. 🔸Remember they are commonly viral & transient bc CLOCC lesions are on the CLOCK ➡️Central Pons: 🔸Usually osmotic demyelination 🔸Remember this bc the T2 hyperintensity is in the shape of O for Osmotic ➡️Dentate: 🔸Usually flagyl toxicity 🔸Remember this bc the wavy appearance of the dentate looks like a FLAG for FLAGyl ➡️Corticospinal tract: 🔸Usually from cobalamin deficienty 🔸Remember cortiCOspinal for CObalamin ➡️Symmetric Gray Matter: 🔸Differential is EXTENSIVE 🔸Remember the differential list for deep gray is deep! ➡️Cortical Gray Matter: 🔸Typically hypoglycemia & hyperammonemia 🔸Remember it looks like the brain has been coated in shimmering sugar = related to glucose 🔸Hyperammonemia has about 1000 Ms in it & the undulated cortex looks like an M ➡️Symmetric White Matter: 🔸Commonly from chasing the dragon (heroin) & methotrexate 🔸Remember that the puffy white matter signal looks like the smoke from a dragon 🔸Remember methotrexate as methoTRACTSate = affects many white matter TRACTS ➡️Posterior subcortical edema: 🔸This is PRES or posterior reversible encephalopathy 🔸So if it’s all POSTERIOR, think POSTERIOR reversible encephalopathy ➡️Asymmetric White Matter: 🔸This is usually demyelinating from chemotherapy 🔸Demyelinating lesions have a C shaped pattern of enhancement 🔸So if you see a C enhancing think of C-hemotherapy Now you know all the toxic/metabolic encephalopathy patterns. So hopefully now remembering the patterns of toxic/metabolic won’t seem so diabolic!

Worried that hydrocephalus is hiding in plain sight?   Normal pressure hydrocephalus (NPH) can mimic volume loss   How can you tell the difference?   Many findings can be seen with NPH—you may use 1 or more.  But do you know how well your sign performs?   Here are how common NPH signs perform:   Evans index SENS: 100 SPEC: 74   Cingulate sulcus sign: SENS: 63 SPEC: 61   Callosal angle: SENS: 49 SPEC: 78   Disproportionately enlarged subarachnoid spaces (DESH): SENS: 94 SPEC: 41   Anteroposterior diameter of the lateral ventricle index: SENS: 98 SPEC: 100   For the SINPHONI trial, a combination of Evans index > 0.3 & DESH had a 70-80% PPV for shunt responsiveness.   Now you know the signs of NPH & how good they may or may not be.  Hopefully, you can now set the bar high when it comes to hydrocephalus!

Be honest!   Do you just say “thalamic infarct” and hope no one asks questions?   Or can you specify the thalamic vascular territories?   Do you know why the whole thalamus doesn’t infarct when you have a PCA infarct? 
Answer:  It’s supplied both by the PCA & PCOMM (ICA)!   Here are the thalamic vascular territories you NEED to know and HOW to remember them.   Tuberothalamic
From the PCOMM Supplies the anterior thalamus I call it the Top-o-the-thalamic to remember its at the top   Paramedian Branch of the P1 ParaMEDIAN is MEDIAL, so it supplies the medial aspect   Posterior choroidal Supplied by the posterior choroidal artery Posterior choroidal is POSTERIOR—it supplies the back of the thalamus   Thalamogeniculate Branch of the P2 Geniculate is by the GENU of the internal capsule, so it is lateral by the internal capsule   Now you know the thalamic vascular territories & you won’t have lie when it comes to these guys!