Cerebro vascular lesions

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Cerebro vascular lesions

  1. 1. Brain Imaging Cerebro-vascular disease Dr. ABD ALLAH NAZEER. MD.
  2. 2. Medulla Oblongata 4th Ventricle Vallecula Cisterna Magna
  3. 3. Post. Fossa level Basilar Art. Prepontine Cistern Ambean Cistern Pones Middle Cerbellar Peduncle 4th Ventricle Cerebellar Hemispheres Vermis
  4. 4. Aqueduct of Sylvius Midbrain Medulla Posterior fossa level Pon s Cerebellar Folia Quadrigeminal Cistern
  5. 5.  Quadrigeminal Cistern Occipital horn, Calc. pineal body Ventricular anatomy
  6. 6. External Capsule Internal Capsule Basal Ganglia Head of caudate Lentiform nucleus Thalamus 3rd Ventricle Quadrigeminal Cistern Insula
  7. 7. Pineal body Inter. Cerebr. veins Vein of Galen Vellum interpositum Retro-thalamic Cistern Retro-thalamic Cistern Sup.cerebellar Cistern Pineal body Inter. Cerebr. veins Quadrigeminal Cistern Retro-thalamic Cistern
  8. 8. Body of caudate Septum Pleusedum
  9. 9. F T F F T O F T O F P O O P P P
  10. 10. F P P Supra-ventricular level P
  11. 11. CT Vascular Anatomy MCA A. Communicating A. ACA (a2) ACA (a1) ICA P. Comm. A. PCA Basilar A.
  12. 12. BRAIN MRI Strong magnetic field and Radiofrequency (RF) coils   Imaging are created by the motion of hydrogen protons in response to the applied radiofrequency  Multiplanar imaging [ axial, sagittal, coronal ] Any MR examination should include T1 and T2 Weighted images
  13. 13. Cerebral lobes
  14. 14. Sulci and gyri
  15. 15. Brodmann Areas
  16. 16. Axial, Sagittal and Coronal MRI Anatomy
  17. 17. MRI Vascular Anatomy
  18. 18. Normal venous sinus anatomy
  19. 19. CT & MRI Terminology  Hypodense= Less dense = Hypointense on MRI.  Hyperdense= more dense= Hyperintense on MRI.  Isodense= of equal density= Isointense on MRI.
  20. 20. Hypo dense Infarction Hyper dense Hemorrhage Isodense ?!
  21. 21. Hypo intense Hyperintense Isointense
  22. 22. CT density [HU ](AV). Brain Parenchyma 30 - 40 HU Hypo dense Normal brain 30-40 HU  CSF 0 -15 HU  Brain edema 20 HU  Infarction 25 HU  Cyst ? Content Fat > - 10 to -150 HU  Air - 2oo HU Infarction   Cyst SOL
  23. 23. Infarction       Is a hypo dense lesion Is not a SOL Hyperacute, Acute , Subacute or chronic Has a vascular territory Has a cortical distribution Account for 80 % of stroke cases.
  24. 24. Infarction phase?! Infarction with edema Acute Infarction with volume loss subacute Chronic
  25. 25. Infarction phase?! Infarction with edema Acute Infarction with volume loss subacute Chronic
  26. 26. Hyperacute finding: Visualization of the clot within the vessel.
  27. 27. Hyperacute and acute finding:
  28. 28. Acute infarction
  29. 29. Acute infarction
  30. 30. Acute One Day Old Infarction Involving the Right Middle Cerebral Artery (MCA) Territory
  31. 31. Acute infarction
  32. 32. Acute infarction with left MCA occlusion
  33. 33. CT study of Brain shows faint low attenuation involving right insular cortex and adjacent basal ganglia - insular ribbon sign. Faint T2 hyperintensity seen on FLAIR. DW images show an obvious infarct with restricted diffusion, seems to be an acute infarct as changes are not marked on FLAIR and CT study. Area of involvement is larger on DW compared to FLAIR, a FLAIR - Diffusion Mismatch.
  34. 34. DWI T2WI
  35. 35. Subacute infarcts 3 weeks after stoke
  36. 36. Chronic infarction Hypodense lesion Loss of volume ( gliosis)→ negative mass effect on the ventricle and sulci [Evacuee dilatation] Porencephaly
  37. 37. Hemorrhagic infarction Infarction with hemorrhagic foci Two main causes :   Venous thrombosis Arterial embolism
  38. 38. Hemorrhagic infarction
  39. 39. Chronic white matter leukoencephalopathy (low grade ischemia)   White matter ischemic changes → diffuse hypo density Hypertensive, diabetic patients
  40. 40. White matter leukoencephalopathy
  41. 41. Lacunar infarctions , 2 Cases
  42. 42. MS PLAQUES  Young age  Close to the ventricles  Perpendicular to the ventricle  High signal in PD or FLAIR  Enhancement of active lesions  Clinical picture
  43. 43. MS PLAQUES with active stage
  44. 44. Intracranial hemorrhage Calvarial bones epidural Subdural Subarachnoid Intracerebral    Intraventricular Acute hematoma ( Hyperdense) Subacute hematoma ( Isodense) Account ( Hypodense) Chronic hematoma of 20 % of strokes.
  45. 45. Anatomic localization Extra axial hematoma = blood extending along the inner skull table = hemorrhage outside the brain parenchyma   Extra axial hemorrhage ( epidural or subdural) Subarachnoid hemorrhage Intra axial hematoma = hemorrhage inside the brain parenchyma
  46. 46. Subarachnoid Hemorrhage Rupture of an anterior Communicating artery aneurysm
  47. 47. Subarachnoid Hemorrhage
  48. 48. Bilateral subarachnoid Hemorrhage
  49. 49. Subarachnoid Hemorrhage at MRI FLAIR images
  50. 50. Subarachnoid Hemorrhage at MRI images
  51. 51. Subdural hematoma  Concave inner margin  Do not cross midline  Can be acute, sub acute or chronic. Can cross the sutures. Epidural hematoma  Convex inner margin Can cross midline Almost always acute. Cannot cross sutures.
  52. 52. Epidural Hematoma Convex inner margin  Almost always acute  Post traumatic 
  53. 53. Epidural Hematoma
  54. 54. Epidural Hematoma
  55. 55. Subacute epidural Hematoma
  56. 56. Subdural Hematoma      Concave inner margin Can be acute , subacute or chronic Usually seen in elderly patient History of minor trauma Can occur in the interhemispheric fissure Chronic Subacute Acute
  57. 57. Subacute hematoma with sedimentation, upper hypodensity and lower hyperdensity Subacute hematoma with re-bleeding, with hypo and hyperdensity blood component
  58. 58. Subacute subdural Hematoma
  59. 59. Subacute subdural Hematoma
  60. 60. Intracerebral hematoma Post-traumatic Hemorrhagic Contusion Right intra-cerebral hematoma
  61. 61. Figure 1: MRI brain (a) and (b) Axial clear T1WI and T2WI showing a large right temporal hetero-intense lesion which is predominantly isointense on T1WI and T2WI and it has a peripheral zone that is hyperintense on T1WI and T2WI suggestive of acute clot. (c) MRI with GADO showing enhancement of the dural-based lesion along the temporal convexity
  62. 62. Intracerebral hematoma
  63. 63. Intra-cerebral and intra-ventricular hematoma
  64. 64. Acute Hematoma [Deoxy – Hb] Low signal T1 WI CT More low signal in T2 WIs
  65. 65. Subacute Hematoma [Met – Hb] High signal T1 WIs High signal in T2 WIs
  66. 66. Intracerebral hematoma subacute
  67. 67. Hyper-acute Hematoma
  68. 68. Intra-cerebral and intra-ventricular hematoma
  69. 69. Cerebral contusion Diffuse axonal injury
  70. 70. Dural sinus thrombosis
  71. 71. Dural sinus thrombosis
  72. 72. Dural sinus thrombosis
  73. 73. Q1, Case. M. EN. P
  74. 74. Q2, Case. EPH
  75. 75. Q3, Case. SDH e cal.

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