Escolar Documentos
Profissional Documentos
Cultura Documentos
medical residents
Floor of sella
ICP
1
3
“ballooning of
sella”
Anatomy
Inferior Medulla
Cerebellar
Pedancle
Temporal
Basillar a. lobe
Pons
Forth ventricle
Pituitary
Fossa
Pons
Forth ventricle
Gyrus rectus of frontal lobe
MCA
Medial
temporal
Amygdala
Midbrain
Ant limb of
Int. capsule Caudate
Putamen
Sylvian fissure
Thalamus
Posterior
Limb of int. capsule
Occipital lobe
Lateral ventricle
Splenium
Frontal lobe
Central sulcus
Parietal lobe
CT brain
Computed tomography (CT) scan
• Cross-sectional representation of
anatomy created by a computer-
generated analysis of the attenuation
of x-ray beams passed through a
section of the body
CT scan: indication
• Primary study of choice in
– Evaluation of acute trauma to the brain
and spine
– Subarachnoid hemorrhage,
– CT is complementary to MR in the
evaluation of the skull base, orbit, and
osseous structures of the spine.
CT scan
• Intravenous contrast is often
administered prior to or during a CT
study to
– identify vascular structures
– detect defects in the blood-brain
barrier (BBB), which are associated with
disorders such as tumors, infarcts, and
infections.
• Carried risk for allergic reaction,
nephrotoxicity
CT scan
• Advantage
• Availability
• Shorter scan time
• Detection of hemorrhage
• Disadvantage
• Contrast media
• Artifacts in posterior fossa or area surrounded by
bone
• Radiation exposure is between 3 and 5 cGy per
study
CT brain check list
• Ventricles
– Any pressure effect on ventricles from edema
– Abnormal dilatation of ventricle
• Contrast enhancement
– Location
– Pattern: nodular, gyral, ring, homogeneous,
inhomogeneous
• Others
– Abnormal vascular structure
– Hyperdense MCA
– Empty delta sign
– Pituitary, pineal
CT brain check list
• Diagnosis
– Diagnosis
– Location and SIDE!!!
– Stage: acute, subacute, chronic (if
indicated)
– Other important findings: eg. With
herniation
MRI
Magnetic resonance imaging (MRI)
MRS
Use of MRI in emergency
situation
T1W T2W
CSF ขาว
CSF ดำ Grey matter เทาอ่ อน
Grey matter เทาเข้ ม White matter เทาเข้ ม
White matter เทาอ่ อน Lesion, edema ขาว
FLAIR (fluid attenuated inversion recovery)
CSF ดำ
Grey matter เทาอ่ อน
White matter เทาเข้ ม
Lesion, edema ขาว
Case 1
• 57 year old woman presented to the
ER with sudden onset left
hemiparesis 2 hours before arriving
at the ER
Answer
CT brain check list
Posterior cerebral a.
Case 2
Lucid interval
EDH: typical lens shaped, 60-90HU
Associated fracture
laceration of middle meningeal
artery
Don’t cross suture
2
1
1
Subdural haematoma
generally more
larger
Collection between
dura and arachnoid
Venous bleeding
May cross suture but
don’t cross midline
Acute SDH: hyperdense
Subacute
Subdural Isodense SDH
haematoma
Subacute SDH: isodense, +C needed
Chronic SDH: hypodensity=CSF
Case 4
Cause
Traumatic
Aneurysmal bleeding
AVM
Extension from intraparenchymal
bleed
Unknown
Perimesencephalic cisterns
(excellent outcome, negative
angiogram)
Subarachnoid
haemorrhage
Non-contrast CT!!!
Axial CT brain : before contrast
injection!!
Case 5
Diagnosis
Acute pontine haemorrhage
Common sites of hypertensive
hemorrhage
• Basal ganglia
• Thalamus
• Cerebellar
• Pons
How do see bleeding on MRI
• Depends on timing after hemorrhage
Bleeding on MRI
Biochem Stage Time T1W T2W
T1W T2W
Acute hematoma
CT T1W T2W
Remote hemorrhage
Hypodensity
lesion at right
parieto-occipital
area
Diagnosis
Pituitary macroadenoma with
suprasellar extension
DDx Craniopharyngioma
Special thanks
• Dr. Chotipat Danchaivijitr
• For these beautiful slides and
images