Neuro examination

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Neuro examination

  1. 1. NEURORADIOLOGY Prof. Dr. Mahmoud El Sheikh Professor of Radiology Faculty of Medicine . University of Alexandria
  2. 2. Imaging Modalities • • • • • • • Conventional Radiography: Plain, Contrast, Fluoro Computed Tomography: MDCT Magnetic Resonance Imaging: fMR, MRS Ultrasonography: Color Doppler Angiography: DSA, MRA, CTA Scintigraphy, SPECT Positron Emission Tomography, PET/CT
  3. 3. Computed Tomography (CT)
  4. 4. Digital Image
  5. 5. CT Tissue Characterization Tissue Contrast depends on Attenuation Number (Hounsfield Unit) Air = -1000 HU Fat = -50 HU Water = 0 HU Soft Tissue = 25-35 HU Acute Hemorrhage = 70-100 HU Calcification = 200-300 HU Cortical Bone >= 1000 HU
  6. 6. IV Contrast Enhancement ► Improves the soft tissue contrast. ► Enhancement depends on:  Extra-axial tissue: vascularity  Intra-axial tissue: BBB Breakdown
  7. 7. Magnetic Resonance (MR) Closed Magnet Open Magnet
  8. 8. Advantages of MR ► No ionizing radiation ► High contrast resolution ► Good spatial resolution ► Multiplanar capabilities ► Multi weighted sequences:      Fluid attenuation (FLAIR) Fat suppression (STIR) Diffusion weighted (DWI) Functional MR (fMR: BOLD) Spectroscopy (MRS)
  9. 9. Protons (nuclei of hydrogen atoms) placed in a strong magnetic field are excited by a radio-frequency pulse, then allowed to loose energy. • The loss of gained energy occurs either to the surrounding matrix (T1) or through interaction between each other (T2). • The loss of energy is measured and used to produce images. •
  10. 10. Normal MR Brain T1 Weighted Image T2 Weighted Image
  11. 11. Other Pulse Sequences Fluid Attenuation (FLAIR) Fat Suppression (STIR)
  12. 12. T1 or T2 Weighted Images ► When reviewing an MR image, the easiest way to determine the type of image, is to look at the cerebrospinal fluid (CSF). ► If the CSF is dark it is a T1-weighted imaged. ► If the CSF is bright, it is a T2-weighted image.
  13. 13. Sagittal MR Brain T1 WI
  14. 14. MR Tissues Signal Characteristics T1 T2 Fluid Dark Bright Fat Bright Dark Solid Grey Bright Subacute Blood Bright Bright Dark Dark Grey Dark Calcifications Flowing Blood Acute, Ch Blood
  15. 15. IV Contrast Enhancement Gadolinium ► Gadolinium increases signal intensity on T1-weighted images through shortening the T1 relaxation time of the tissue. ► Enhancement depends on:  Extra-axial tissue: vascularity  Intra-axial tissue: BBB Breakdown
  16. 16. BRAIN
  17. 17. TRAUMA
  18. 18. Plain X-Ray Fracture Line SKULL FRACTURE
  19. 19. Digital Image Soft Tissue Window Bone Window
  20. 20. Traumatic Cranio-Cerebral Lesions
  21. 21. Brain Contusions Hemorrhagic Contusions
  22. 22. Brain Lacerations R Gunshot Injury
  23. 23. Extradural Hematoma
  24. 24. Subdural Hematoma
  25. 25. Subacute Subdural Hematoma
  26. 26. Subarachnoid Hemorrhage
  27. 27. Diffuse Axonal Injury (DAI)
  28. 28. Generalized Brain Edema
  29. 29. Mass Effect Brain Herniation Mass Brain Stem
  30. 30. Decompressive Craniectomy
  31. 31. Non-Traumatic Hemorrhage
  32. 32. Non-Traumatic Intracranial Hemorrhage ► Very    ► Hypertension Aneurysm Vascular Malformation AVM Common       ► Common Embolic stroke with reperfusion Amyloid angiopathy Prematurity (Germinal Matrix Hemorrhage) Coagulopathies Drug abuse Tumor Uncommon  Venous infarct  Vasculitis
  33. 33. Hypertensive Hemorrhage
  34. 34. Massive Hypertensive Hemorrhage
  35. 35. Hemorrhage in Arterio-Venous Malformation (AVM)
  36. 36. Subarachnoid Hemorrhage
  37. 37. Anterior Communicating Aneurysm
  38. 38. Posterior Communicating Aneurysm
  39. 39. Cerebral Angiography
  40. 40. Cerebral Angiography ► Direct Angiography ► Catheter Angiography:  Conventional  Digital Subtraction ► Magnetic Resonance Angiography (MRA) ► Computed Tomography Angiography (CTA)
  41. 41. Anterior Communicating Artery Aneurysm MR Angiography
  42. 42. Middle Cerebral Artery Aneurysm CT Angiography
  43. 43. Infarct
  44. 44. Cerebral Arteries Territories Anterior CA Middle CA Posterior CA
  45. 45. Anterior Cerebral Infarct
  46. 46. Acute Middle Cerebral Infarct
  47. 47. Posterior Cerebral Infarct
  48. 48. Focal Thalamic Infarct T1 WI T2 WI Magnetic Resonance
  49. 49. Brain Stem Infarct T2 WI
  50. 50. Early Infarct CT
  51. 51. Early Infarct CT Perfusion MR Diffusion
  52. 52. Perfusion/Diffusion Mismatch Penumbra
  53. 53. Old Infarct
  54. 54. Neuro-Intervention
  55. 55. Embolization of AVM Before After
  56. 56. Occluding Aneurysm with Coils Before After
  57. 57. Balloon Angioplasty Before After
  58. 58. Brain Lesions
  59. 59. Parameters Used In Lesions Diagnosis  Age  Clinical presentation  Location  Characteristic imaging features Similar lesions have Similar imaging features
  60. 60. Brain Aging Involutional Changes
  61. 61. Hydrocephalus Aqueduct Stenosis
  62. 62. Herpes Virus Encephalitis T1 WI T2 WI
  63. 63. Pyogenic Brain Abscess
  64. 64. Multiple Sclerosis
  65. 65. Brain Tumors
  66. 66. Glioma T1 WI T2 WI T1 WI Post-Contrast
  67. 67. Glioblastoma Multiforme
  68. 68. Oligodendroglioma
  69. 69. Sellar & Suprasellar Tumors
  70. 70. Pituitary Adenoma
  71. 71. Brain stem Glioma
  72. 72. Cerebello-Pontine Angle Tumors
  73. 73. Acoustic Neurinoma Post Contrast CT Bone Window CT
  74. 74. Acoustic Neurinoma T1 WI T1 WI Post Contrast MR
  75. 75. Meningioma T1 WI T1 WI Post Contrast MR
  76. 76. Metastases
  77. 77. Metastases
  78. 78. SPINE
  79. 79. Anatomy
  80. 80. Plain X-Ray A-P view Lateral view Oblique view
  81. 81. MYELOGRAPHY
  82. 82. CT
  83. 83. MR T1 WI T2 WI
  84. 84. Sagittal View T1 WI T2 WI MR
  85. 85. Parasagittal View T2 WI T1 WI MR
  86. 86. Spinal Trauma CT Plain x-ray T1 WI
  87. 87. Traumatic Cord Contusion T2 WI
  88. 88. Normal Intervertebral Disc Epidural Fat Nerve Root Thecal Sac Epidural Fat Disc
  89. 89. Disc Herniation CT Normal Disc Rt Postero-lateral Herniation Lt Foraminal Herniation
  90. 90. Disc Herniation MR T1 WI T2 WI
  91. 91. Disc Herniation T1 WI T2 WI
  92. 92. Caudal Migration
  93. 93. Sequestrated Disc
  94. 94. Post-Operative Spine Recurrent Disc/Scar tissue Enhancing Scar Nerve Root T1 WI PreContrast T1 WI PostContrast
  95. 95. Degenerative Changes Lateral Recess Disc bulge with vacuum Apophyseal Arthrosis
  96. 96. Spinal Canal Stenosis Developmental Degenerative
  97. 97. Central Spinal Canal Stenosis MR Thickened Ligamenta Flava CT Calcified Ligamenta Flava
  98. 98. Foraminal Stenosis
  99. 99. Compression Myelomalacia
  100. 100. Spondylolisthesis Spondylolisthesis is forward sliding of a vertebra over the vertebra below. Types: ► Lytic ► Degenerative
  101. 101. Lytic Spondylolisthesis Defect in Pars Inter-articularis
  102. 102. Pars Interarticularis
  103. 103. Degenerative Spondylolisthesis
  104. 104. Infective Spondylitis T1WI T1WI Post Contrast
  105. 105. Transverse Myelitis T2 WI
  106. 106. Syringomyelia T1 WI
  107. 107. Glioma T1 WI POST CONTRAST
  108. 108. Meningioma T1 WI POST CONTRAST
  109. 109. Metastases CT Soft tissue Window Bone Window MR T1 WI
  110. 110. Isotope Bone Scan Normal Deposits
  111. 111. THANK YOU Prof Dr Mahmoud El Sheikh

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