Brain ct and mri in icu
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This document provides an overview of various brain conditions that can be visualized using CT and MRI imaging in an ICU setting. It describes normal brain anatomy on CT and several abnormal findings including skull fractures, subarachnoid hemorrhage from aneurysms, hydrocephalus, strokes, brain tumors, infections, and atrophy seen in persistent vegetative states. The document emphasizes how different pathologies appear on CT versus MRI scans and explains the clinical significance and typical outcomes of several conditions.
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Brain ct and mri in icu
This document provides an overview of brain CT and MRI imaging in the intensive care unit (ICU). It includes examples of normal and abnormal brain scans showing various pathologies like fractures, hemorrhages, strokes, tumors, and infections. CT scans demonstrate bone fractures while MRI provides better soft tissue contrast for visualizing conditions such as strokes, abscesses, and tumors. The document aims to educate ICU physicians and nurses on interpreting common brain imaging findings.
Brain CT & MRI
This document contains a series of CT images with labels of brain anatomy. It also includes short descriptions of various brain injuries and conditions that can be seen on CT such as skull fractures, subarachnoid hemorrhage, epidural hematoma, diffuse axonal injury, cerebral contusion, intraventricular hemorrhage, and intracerebral hemorrhage. The document was created by Dr. Ebrahim Jalili and contains educational information aimed at interpreting CT scans of the brain.
Brain aneurysm
Brain aneurysm is an abnormal bulging and protruding of one of the arteries inside the brain. Brain aneurysm mainly develops at the junctions of the large arteries present at the base of the brain, in a region called circle of wills. Brain aneurysm can be life threatening and one should seek immediate medical attention.
Cerebral Ischemia
This document discusses CT imaging findings of cerebral ischemia and infarction at different stages. It begins with an overview of the major types of stroke and their causes. It then discusses the pathophysiology of cerebral ischemia and infarction, highlighting the central ischemic focus and less dense ischemic penumbra. Next, it details the imaging appearance of acute, subacute, and chronic infarcts on CT. It notes the hyperdense artery sign seen in some acute infarcts. For subacute infarcts, it describes increased mass effect and hemorrhagic transformation seen 1-7 days later. It also briefly discusses lacunar infarcts and hypoxic-ischemic encephalopathy.
Head ct scan general part one
CT scans of the head are used to evaluate conditions like head injuries, strokes, and seizures. A head CT involves placing the patient on a table that slides into a rotating X-ray tube to take images of the brain and skull. Abnormal findings may include skull fractures from head injuries, bleeding within the brain from strokes or injuries, and blockages or lesions within the brain. CT scans are analyzed to diagnose conditions and guide further treatment.
Complete Information on Cerebral Aneurysm or Brain Aneurysm
A cerebral aneurysm is a bulging, weak spot on a blood vessel in the brain that can fill with blood and put pressure on surrounding tissues. It may also leak or rupture, spilling blood into the brain. Cerebral aneurysms most often occur along arteries at the base of the skull. They can be present from birth or develop later due to injury. Symptoms may include headaches, double vision, or eye pain if the aneurysm pushes on brain structures. Tests like CT scans, MRIs, eye exams, and angiograms can diagnose cerebral aneurysms and detect any bleeding in the brain.
Ct head
This document discusses head trauma and various types of brain injuries seen on CT imaging. It provides details on:
1) Classification of head injuries as mild, moderate or severe based on Glasgow Coma Scale. It also describes primary injuries that occur at the time of trauma versus secondary injuries that develop later.
2) Common primary brain injuries seen on CT such as epidural hematomas, subdural hematomas, skull fractures, cerebral contusions, and diffuse axonal injury.
3) Guidelines for use of head CT in traumatic brain injury patients based on American College of Radiology criteria, New Orleans Criteria, and Canadian Head CT Rule.
4) Features of various types of skull fractures,
Anterior cerebral circulation
The document discusses the anterior cerebral circulation, including the internal carotid artery, anterior cerebral artery, and middle cerebral artery. It describes the typical vascular territories and clinical deficits that can result from occlusions or infarctions in different segments of these arteries. Key points include that unilateral middle cerebral artery occlusion can cause contralateral hemiplegia and homonymous hemianopia, while bilateral anterior cerebral artery occlusion can lead to paraplegia and urinary incontinence.
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Brain ct and mri in icu
This document provides an overview of brain CT and MRI imaging in the intensive care unit (ICU). It includes examples of normal and abnormal brain scans showing various pathologies like fractures, hemorrhages, strokes, tumors, and infections. CT scans demonstrate bone fractures while MRI provides better soft tissue contrast for visualizing conditions such as strokes, abscesses, and tumors. The document aims to educate ICU physicians and nurses on interpreting common brain imaging findings.
Brain CT & MRI
This document contains a series of CT images with labels of brain anatomy. It also includes short descriptions of various brain injuries and conditions that can be seen on CT such as skull fractures, subarachnoid hemorrhage, epidural hematoma, diffuse axonal injury, cerebral contusion, intraventricular hemorrhage, and intracerebral hemorrhage. The document was created by Dr. Ebrahim Jalili and contains educational information aimed at interpreting CT scans of the brain.
Brain aneurysm
Brain aneurysm is an abnormal bulging and protruding of one of the arteries inside the brain. Brain aneurysm mainly develops at the junctions of the large arteries present at the base of the brain, in a region called circle of wills. Brain aneurysm can be life threatening and one should seek immediate medical attention.
Cerebral Ischemia
This document discusses CT imaging findings of cerebral ischemia and infarction at different stages. It begins with an overview of the major types of stroke and their causes. It then discusses the pathophysiology of cerebral ischemia and infarction, highlighting the central ischemic focus and less dense ischemic penumbra. Next, it details the imaging appearance of acute, subacute, and chronic infarcts on CT. It notes the hyperdense artery sign seen in some acute infarcts. For subacute infarcts, it describes increased mass effect and hemorrhagic transformation seen 1-7 days later. It also briefly discusses lacunar infarcts and hypoxic-ischemic encephalopathy.
Head ct scan general part one
CT scans of the head are used to evaluate conditions like head injuries, strokes, and seizures. A head CT involves placing the patient on a table that slides into a rotating X-ray tube to take images of the brain and skull. Abnormal findings may include skull fractures from head injuries, bleeding within the brain from strokes or injuries, and blockages or lesions within the brain. CT scans are analyzed to diagnose conditions and guide further treatment.
Complete Information on Cerebral Aneurysm or Brain Aneurysm
A cerebral aneurysm is a bulging, weak spot on a blood vessel in the brain that can fill with blood and put pressure on surrounding tissues. It may also leak or rupture, spilling blood into the brain. Cerebral aneurysms most often occur along arteries at the base of the skull. They can be present from birth or develop later due to injury. Symptoms may include headaches, double vision, or eye pain if the aneurysm pushes on brain structures. Tests like CT scans, MRIs, eye exams, and angiograms can diagnose cerebral aneurysms and detect any bleeding in the brain.
Ct head
This document discusses head trauma and various types of brain injuries seen on CT imaging. It provides details on:
1) Classification of head injuries as mild, moderate or severe based on Glasgow Coma Scale. It also describes primary injuries that occur at the time of trauma versus secondary injuries that develop later.
2) Common primary brain injuries seen on CT such as epidural hematomas, subdural hematomas, skull fractures, cerebral contusions, and diffuse axonal injury.
3) Guidelines for use of head CT in traumatic brain injury patients based on American College of Radiology criteria, New Orleans Criteria, and Canadian Head CT Rule.
4) Features of various types of skull fractures,
Anterior cerebral circulation
The document discusses the anterior cerebral circulation, including the internal carotid artery, anterior cerebral artery, and middle cerebral artery. It describes the typical vascular territories and clinical deficits that can result from occlusions or infarctions in different segments of these arteries. Key points include that unilateral middle cerebral artery occlusion can cause contralateral hemiplegia and homonymous hemianopia, while bilateral anterior cerebral artery occlusion can lead to paraplegia and urinary incontinence.
Ct scan lecture
This document summarizes key information about different types of strokes that can occur in different areas of the brain:
1) Anterior cerebral artery strokes can cause contralateral leg weakness and sensory loss as well as behavioral abnormalities and incontinence.
2) Middle cerebral artery strokes typically cause hemiplegia of the contralateral side affecting the lower face, arm and hand while sparing the leg, as well as contralateral sensory loss and visual field deficits.
3) Posterior cerebral artery strokes commonly cause visual deficits like contralateral homonymous hemianopia since the occipital lobe is responsible for vision.
middle cerebral artery anatomy
The MCA is the largest and most complex of the cerebral arteries. It arises from the internal carotid artery and has four segments - M1, M2, M3, M4. The M1 segment can be further divided into pre-bifurcation and post-bifurcation parts. Early branches and perforating arteries originate from the M1 segment. The MCA has a variable branching pattern and anomalies include duplication, accessory branches, and fenestration. Key angiographic landmarks include the Sylvian point and Sylvian triangle.
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Brain haemorrhage is caused when the nerve in the brain burst due to various issues. It can be external or internal too.
Imaging in head trauma
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stroke
This document defines stroke as an acute CNS injury resulting from reduced blood flow to the brain. Strokes can be ischemic, caused by blockage of a blood vessel, or hemorrhagic, caused by rupture of a blood vessel. The main types of ischemic stroke are thrombotic, caused by clots within blood vessels, and embolic, caused by clots or debris traveling from elsewhere. Cardioembolic strokes are a type of embolic stroke where clots originate from the heart. Risk factors, signs and symptoms, treatment, and the effects of left versus right brain strokes are described. Transient ischemic attacks are also summarized.
Head ct
Blood can cause serious problems in a head trauma. A head CT can identify if there is blood in the brain (intraaxial lesions), around the brain (extraaxial hematomas), or in the cisterns and ventricles. A head CT is useful for evaluating size, signs/symptoms, shifts in midline structures, side, and site of extraaxial hematomas. It can also identify fractures and pneumocephalus. Understanding head CT anatomy is important for properly evaluating head trauma.
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The document discusses diagnostic radiology of the central nervous system. It begins with an outline and overview of normal brain anatomy and imaging features. It then describes basic features seen in common brain lesions including hydrocephalus, brain atrophy, necrosis, calcification, and mass effect. Specific pathologies covered include brain tumors, cerebrovascular diseases like hemorrhage, aneurysms, and infarction, as well as traumatic brain injuries such as epidural and subdural hematomas. Key imaging findings on CT and MRI for various acute and chronic stages are highlighted.
Ischaemic Stroke Overview
1. An ischemic stroke occurs when a blood clot or fat deposit blocks an artery in the brain, cutting off blood flow and oxygen to brain cells.
2. There are two main types - arterial thrombosis where a clot forms in the brain artery, and cerebral embolism where a clot forms elsewhere and travels to the brain.
3. Risk factors include age, gender, medical conditions like high blood pressure, smoking, high cholesterol, prior transient ischemic attacks, and family history.
Neuroradiology Head Trauma
Epidural hematoma results from skull fractures that cause bleeding between the dura and skull. It presents as a lenticular or biconvex mass that cannot cross suture lines. Subdural hematoma occurs between the dura and arachnoid membranes from cortical vein tears. It appears as a crescent-shaped mass that can cross sutures. Both require urgent CT imaging and surgical evacuation via burr holes.
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This document provides an overview of cerebrovascular accidents (CVAs), also known as strokes. It defines CVAs, describes the blood supply to the brain, and classifies the major types of strokes as ischemic (caused by reduced blood flow) or hemorrhagic (caused by bleeding). It discusses the causes, risk factors, clinical presentation, progression, and management of different stroke subtypes, including transient ischemic attacks, infarction, and intracerebral hemorrhage.
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This document discusses the use of various imaging modalities such as CT, MRI, CTA, and CTP in evaluating patients presenting with acute stroke. It outlines the goals of acute stroke imaging as establishing the diagnosis, obtaining information on vasculature, and guiding appropriate therapy. CT is described as the initial test to rule out hemorrhage and identify early signs of infarction. MRI sequences such as DWI, T2WI, and FLAIR are also summarized. The roles of CTA in evaluating vessels and CTP in identifying tissue at risk of infarction are covered. Imaging findings of ischemic and hemorrhagic stroke subtypes are presented.
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The document discusses stroke, including its pathophysiology, types, risk factors, and management categories. Key points include:
- Stroke is caused by interrupted blood flow to the brain and can be ischemic (caused by clots or blockages) or hemorrhagic (caused by bleeding).
- Major risk factors include age, gender, race, family history, diabetes, heart disease, smoking, hypertension, and obesity.
- Strokes are classified based on location and cause, such as thrombotic, embolic, or hemorrhagic strokes.
- Complications include sensory and motor deficits, speech/swallowing issues, and cognitive/emotional changes.
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CT and MRI are commonly used imaging modalities to evaluate the brain and spine. CT can clearly image bone structures and is useful for detecting fractures, while MRI provides excellent soft tissue contrast and is more sensitive for abnormalities within the brain and spinal cord. Some key applications discussed include using CT to identify intracranial hemorrhages such as epidural, subdural, subarachnoid, and intraventricular bleeds. CT is also used to diagnose strokes, brain tumors, hydrocephalus, and traumatic injuries. MRI is superior for evaluating many conditions like brain infarctions, demyelinating diseases, and spinal disc herniations. Both modalities have advantages and can be complementary in the evaluation of many neurological
How to read a brain ct scan moderate
This document provides information about performing and interpreting head CT scans. It discusses:
1. How a head CT is performed, including positioning the patient supine and rotating the x-ray tube around the head.
2. Key aspects of head CT scans like typical slice thickness of 5-10mm, use of contrast, and transverse plane images.
3. Interpreting head CTs by understanding Hounsfield units and attenuation values of different tissues, as well as normal cranial anatomy visible on scans.
4. Common pathologies that can be identified on head CTs such as traumatic injuries, hemorrhages, strokes, and tumors.
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This document summarizes key information about different types of strokes that can occur in different areas of the brain:
1) Anterior cerebral artery strokes can cause contralateral leg weakness and sensory loss as well as behavioral abnormalities and incontinence.
2) Middle cerebral artery strokes typically cause hemiplegia of the contralateral side affecting the lower face, arm and hand while sparing the leg, as well as contralateral sensory loss and visual field deficits.
3) Posterior cerebral artery strokes commonly cause visual deficits like contralateral homonymous hemianopia since the occipital lobe is responsible for vision.
middle cerebral artery anatomy
The MCA is the largest and most complex of the cerebral arteries. It arises from the internal carotid artery and has four segments - M1, M2, M3, M4. The M1 segment can be further divided into pre-bifurcation and post-bifurcation parts. Early branches and perforating arteries originate from the M1 segment. The MCA has a variable branching pattern and anomalies include duplication, accessory branches, and fenestration. Key angiographic landmarks include the Sylvian point and Sylvian triangle.
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Brain haemorrhage is caused when the nerve in the brain burst due to various issues. It can be external or internal too.
Imaging in head trauma
Brain imaging is important in trauma to identify injuries from primary impact and secondary complications. CT is best for acute trauma to detect fractures and hemorrhages while MRI is more sensitive for diffuse injuries. Common primary injuries seen include fractures, contusions, hematomas, shearing injuries and hemorrhages in various locations. Secondary complications can include swelling, infection and herniations putting pressure on vessels.
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This document defines stroke as an acute CNS injury resulting from reduced blood flow to the brain. Strokes can be ischemic, caused by blockage of a blood vessel, or hemorrhagic, caused by rupture of a blood vessel. The main types of ischemic stroke are thrombotic, caused by clots within blood vessels, and embolic, caused by clots or debris traveling from elsewhere. Cardioembolic strokes are a type of embolic stroke where clots originate from the heart. Risk factors, signs and symptoms, treatment, and the effects of left versus right brain strokes are described. Transient ischemic attacks are also summarized.
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Blood can cause serious problems in a head trauma. A head CT can identify if there is blood in the brain (intraaxial lesions), around the brain (extraaxial hematomas), or in the cisterns and ventricles. A head CT is useful for evaluating size, signs/symptoms, shifts in midline structures, side, and site of extraaxial hematomas. It can also identify fractures and pneumocephalus. Understanding head CT anatomy is important for properly evaluating head trauma.
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Skull and brain imaging techniques such as CT and MRI are standard for investigating trauma, while ultrasound angiography is limited to detecting stenosis, aneurysms, and arteriovenous malformations. CT is useful for detecting fractures, edema, contusions, hemorrhages, and other abnormalities. MRI provides additional information on lesions and is more accurate for diagnosing conditions such as multiple sclerosis and arteriovenous malformations. Various imaging findings help characterize common brain pathologies including tumors, infarcts, hemorrhages, and infections.
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This document provides information on stroke and cerebrovascular accidents. It defines different types of strokes including transient ischemic attack (TIA), reversible ischemic neurological deficit (RIND), and completed stroke. It describes how to diagnose a stroke by determining the neurological deficit, lesion location, type of lesion, and cause. Risk factors, signs and symptoms, and methods of examination are discussed. The anatomy and blood supply of the brain are outlined. Common sites and types of infarction and hemorrhage are also summarized.
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The document discusses diagnostic radiology of the central nervous system. It begins with an outline and overview of normal brain anatomy and imaging features. It then describes basic features seen in common brain lesions including hydrocephalus, brain atrophy, necrosis, calcification, and mass effect. Specific pathologies covered include brain tumors, cerebrovascular diseases like hemorrhage, aneurysms, and infarction, as well as traumatic brain injuries such as epidural and subdural hematomas. Key imaging findings on CT and MRI for various acute and chronic stages are highlighted.
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1. An ischemic stroke occurs when a blood clot or fat deposit blocks an artery in the brain, cutting off blood flow and oxygen to brain cells.
2. There are two main types - arterial thrombosis where a clot forms in the brain artery, and cerebral embolism where a clot forms elsewhere and travels to the brain.
3. Risk factors include age, gender, medical conditions like high blood pressure, smoking, high cholesterol, prior transient ischemic attacks, and family history.
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Epidural hematoma results from skull fractures that cause bleeding between the dura and skull. It presents as a lenticular or biconvex mass that cannot cross suture lines. Subdural hematoma occurs between the dura and arachnoid membranes from cortical vein tears. It appears as a crescent-shaped mass that can cross sutures. Both require urgent CT imaging and surgical evacuation via burr holes.
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Dr. Hompriya Issar is a neurosurgeon in Greater Noida who specializes in treating brain aneurysms. A brain aneurysm is a bulge or ballooning in a blood vessel in the brain that can cause severe headaches, blurred vision, or loss of consciousness. There are several treatment options for brain aneurysms including medical therapy, surgical clipping, or endovascular therapy. Dr. Issar has over 10 years of experience and provides high-quality medical and surgical care for neurology patients.
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The document defines various types of strokes and transient ischemic attacks. It discusses the epidemiology, risk factors, clinical features, investigations, and management of strokes. The main types are ischemic and hemorrhagic strokes. Investigations include brain imaging like CT scan and MRI to identify the type of stroke and underlying causes. Treatment focuses on minimizing brain damage, preventing complications, rehabilitation, and reducing the risk of recurrence.
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This document provides an overview of cerebrovascular accidents (CVAs), also known as strokes. It defines CVAs, describes the blood supply to the brain, and classifies the major types of strokes as ischemic (caused by reduced blood flow) or hemorrhagic (caused by bleeding). It discusses the causes, risk factors, clinical presentation, progression, and management of different stroke subtypes, including transient ischemic attacks, infarction, and intracerebral hemorrhage.
Imaging in acute stroke
This document discusses the use of various imaging modalities such as CT, MRI, CTA, and CTP in evaluating patients presenting with acute stroke. It outlines the goals of acute stroke imaging as establishing the diagnosis, obtaining information on vasculature, and guiding appropriate therapy. CT is described as the initial test to rule out hemorrhage and identify early signs of infarction. MRI sequences such as DWI, T2WI, and FLAIR are also summarized. The roles of CTA in evaluating vessels and CTP in identifying tissue at risk of infarction are covered. Imaging findings of ischemic and hemorrhagic stroke subtypes are presented.
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This document provides an overview of CT and MRI indications, techniques, findings, and interpretations for various brain pathologies. It discusses stroke imaging including early signs of ischemia on CT and advantages of MRI diffusion weighted imaging. It also covers trauma, infections, tumors and white matter diseases. Key points include sensitivity of imaging modalities for acute vs. chronic hemorrhage, importance of excluding hemorrhage for thrombolysis, and assessing penumbra on perfusion studies.
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The document discusses stroke, including its pathophysiology, types, risk factors, and management categories. Key points include:
- Stroke is caused by interrupted blood flow to the brain and can be ischemic (caused by clots or blockages) or hemorrhagic (caused by bleeding).
- Major risk factors include age, gender, race, family history, diabetes, heart disease, smoking, hypertension, and obesity.
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CEREBRAL INFARCTS
Pathophysiology
Significantly diminished blood supply to all parts(global ischemia) or selected areas(regional or focal ischemia) of the brain
Focal ischemia- cerebral infarction
Global ischemia-hypoxic ischemic encephalopathy(HIE), hypotensive cerebral infarction
Infarct vs pneumbra
In the central core of the infarct, the severity of hypoperfusion results in irreversible cellular damage
Around this core, there is a region of decreased flow in which either:
The critical flow threshold for cell death has not reached
Or the duration of ischemia has been insufficient to cause irreversible damage.
Current therapies attempt to rescue these ‘at risk’ cells
Goal of imaging
Exclude hemorrhage
Identify the presence of an underlying structural lesion such as tumour , vascular malformation, subdural hematoma that can mimic stroke
Identify stenosis or occlusion of major extra- and intracranial arteries
Differentiate between irreversibly affected brain tissue and reversibly impaired tissue (dead tissue versus tissue at risk)
Imaging modalities
CT
MRI
Diffusion weighted imaging
MRA
MRS
CT angiography
CT perfusion imaging
Perfusion-weighted MR Imaging
Trans cranial doppler
Cerebral angiography
Classification
Hyper acute infarct (<12 hours)
Acute infarct (12 to 48 hours)
Subacute infarct (2 to 14 days)
Chronic infarct (>2 weeks)
Old infarct (> 8 to 10 weeks)
CT-Hyperacute infarct
Normal in 50 – 60%
Hyperdense MCA sign-acute intraluminal thrombus
Obscuration of lentiform nulei
Dot sign-occluded MCA branch in sylvian fissure
Insular ribbon sign –grey white interface loss along the lateral insula
Hyperdense MCA sign
Obscuration of lentiform nuclei
Insular ribbon sign
Insular ribbon sign
MRI –Hyperacute infarct
Absence of normal flow void with intra vascular arterial enhancement
Anatomic changes in T1WI
Sulcal effacement,
Gyral edema,
Loss of grey white interface
Sulcal effacement
CT- Acute infarct
Low density basal ganglia
Sulcal effacement
Wedge shaphed parenchymal hypo density area that involves both grey and white matter
Increasing mass effect
Hemorrhagic transformation may occur -15 to 45% ( basal ganglia and cortex common site) in 24 to 48 hours
Sulcal effacement
MRI –Acute infarct
T2WI-hyperintensity in affected area
Meningeal enhancement adjacent to infarct(12 to 24 hours)
Early parenchymal enhancement
Hemorrhagic transformation becomes evident
MRI –Acute infarct
MRI –Acute infarct
CT – sub acute infarct
NECT
Wedge-shaped area of decreased attenuation involving gray/white matter in typical vascular distribution
Mass effect initially increases, then begins to
diminish by 7-10 days
HT of initially ischemic infarction occurs in 15-20% of MCA occlusions, usually by 48-72 hrs
CECT
Enhancement patterns typically patchy or gyral
May appear as early as 2-3 days after ictus, persisting up to 8-10 weeks
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Cranial CT is a useful diagnostic tool in the emergency room that physicians need to be able to accurately interpret without specialist assistance. CT imaging works by passing collimated X-rays through the patient which are detected on the other side and assembled into cross-sectional images. Different tissues absorb X-rays to different degrees, appearing as different shades of grey on the image. The "blood can be very bad" mnemonic directs physicians to examine the blood, cisterns, brain, ventricles, and bone for abnormalities such as hemorrhage, increased intracranial pressure, infarcts, and space-occupying lesions. Contrast injection helps identify enhancing lesions including tumors, abscesses, and infections
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This document discusses various types of head injuries that can be diagnosed using CT scans. It describes epidural hematomas, which present as lenticular shaped masses between the brain and skull, most commonly in the temporoparietal region from injuries to the middle meningeal artery. Subdural hematomas appear as crescent shaped collections along the brain surface and are more common in elderly patients. Intracerebral hemorrhages can be difficult to distinguish from spontaneous bleeds but often involve the frontal and temporal lobes. Diffuse injuries like shearing injuries may show little on scans but can be severely disabling. The document provides details on interpreting CT scans to diagnose various head injury complications.
Acute brain
The document provides an overview of brain anatomy and various types of head injuries and brain hemorrhages that can be seen on CT imaging. It begins with a brief description of brain anatomy including skull bones, meninges, ventricles, and cortical structures. It then discusses different types of head trauma such as skull fractures, depressed fractures, and basilar fractures. Finally, it covers brain hemorrhages including extra-axial hemorrhages like epidural hematomas and subdural hematomas, as well as subarachnoid hemorrhage and intra-axial bleeding.
Imaging in stroke
This document discusses stroke, including its types, causes, pathophysiology, imaging findings, and clinical features. It provides the following key points:
1. Stroke is caused by ischemia or hemorrhage in the brain. The main types are cerebral infarction (80%), intracerebral hemorrhage (15%), and subarachnoid hemorrhage (5%).
2. Imaging plays an important role in assessing the parenchyma, vessels, perfusion, and penumbra to guide therapy and predict outcomes. Techniques include CT, MRI, CT/MR perfusion, and angiography.
3. CT findings evolve over time from hyperacute to chronic stages. Early signs include
Anatomy of normal ct brain
1) The document provides an overview of the normal anatomical structures visible on CT scans of the brain, including the skull, meninges, ventricles, lobes, grey and white matter structures.
2) Key structures discussed include the cerebrum, cerebellum, brainstem, basal ganglia, thalamus, internal capsules, and corpus callosum.
3) The techniques for performing head CT scans are outlined, along with slice thickness and use of intravenous contrast.
Subarachnoid hemorrhage
The subarachnoid space is located between the arachnoid membrane and pia mater in the brain. It contains cerebrospinal fluid and spongy connective tissue. Bleeding into this space is called a subarachnoid hemorrhage (SAH), which is often caused by the rupture of an intracranial aneurysm. CT and MRI are used to detect SAH. Treatment involves relieving vasospasm, removing blood, and clipping or coiling the aneurysm to prevent rebleeding. Complications include hydrocephalus, infarction, and herniation. The mortality rate of SAH is 30-60% even after reaching the hospital.
Ct basics
CT scans provide detailed images of brain tissue by measuring tissue density in Hounsfield units. Different tissues have characteristic densities: air is -1000 HU, fat is -70 HU, water is 0 HU, CSF is +8 HU, gray matter is +45 HU, and bone is +1000 HU. CT is useful for identifying acute cerebral infarctions at different stages from hyperacute to chronic based on characteristics such as tissue density and enhancement patterns. Common vascular territories and watershed areas are also identifiable on CT scans.
Intro Head CT.ppt
This document provides an introduction to head CT imaging. It discusses the basics of CT, including how it uses x-rays to provide axial brain views and measures tissue density. It outlines an ABBBC approach to reading CT scans, focusing on air-filled structures, bones, blood, brain tissue, and CSF spaces. The document reviews normal brain anatomy and identifies various pathologies that can be seen on head CT such as hemorrhages, infarcts, masses and herniations. It provides examples of interpreting CT scans using the ABBBC method.
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This document provides an introduction to head CT imaging. It discusses the basics of CT, including how it uses x-rays to provide axial brain views and measures tissue density. It outlines an ABBBC approach to reading CT scans, focusing on air-filled structures, bones, blood, brain tissue, and CSF spaces. The document reviews normal brain anatomy and identifies various pathologies that can be seen on head CT such as hemorrhages, infarcts, masses and herniations. It provides examples of interpreting CT scans using the ABBBC method.
Imaginginacutestroke dr anoop.k.r
This document provides an overview of imaging in acute stroke, including CT and MRI. CT is often the initial imaging modality used to rule out hemorrhage. Early CT signs of infarction include hypodensity, obscuration of the lentiform nucleus, and the insular ribbon sign. Diffusion-weighted MRI is the most sensitive sequence for detecting acute ischemia. MRI can identify irreversibly injured tissue as well as potentially salvageable penumbral tissue. CT and MR angiography can detect vessel occlusions. CT perfusion can identify regions of low blood flow and volume that are at risk of infarction. The document reviews imaging findings over time and discusses venous infarcts.
Traumatic brain injury
There are several types of traumatic brain injuries that can result from head trauma:
1. Epidural hematoma occurs when a skull fracture ruptures a meningeal artery, resulting in blood accumulating between the dura and skull. It appears as a biconvex mass on CT scan.
2. Subdural hematoma occurs when bridging veins are damaged, resulting in blood accumulating between the dura and arachnoid. It appears as a crescent-shaped mass on CT scan.
3. Contusions and lacerations are bruises and tears of brain tissue that appear as low-density regions on CT scan.
CT Scan - Basics
CT scanning provides images of brain tissue based on density differences detected by x-rays. The images produced use Hounsfield units to represent densities on a scale where air is -1000 and bone is +1000. On CT, white matter appears darker than gray matter and CSF appears black. Common sequences seen on CT include axial, coronal, and sagittal cuts at various anatomical levels. CT is used to identify acute ischemic strokes within 12 hours by detecting hyperdense arteries, and in subsequent days can identify low density infarcts and hemorrhagic transformations. Chronic infarcts appear as well-defined low attenuation areas.
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Central and arterial lines are catheters used to provide venous or arterial access. Central lines terminate in the superior vena cava or right atrium, while arterial lines are placed in peripheral arteries like the radial artery. They are used to administer fluids/drugs, monitor pressures, or obtain blood samples. Complications include infection, bleeding, air embolism, and thrombosis. When managing patients with lines, nurses monitor for complications, secure connections, and remove lines per indications to prevent issues.
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- 1. BRAIN CT AND MRI IN ICU SAMIR EL ANSARY
- 2. A Quick Primer of Brain CT/MRI
- 3. Normal CAT of brain Ventricles are normal sized, the grey versus white distinction is clear. Midline is straight. Sulci are symmetrical on both sides. Skull is intact with no scalp edema.
- 4. Severe brain trauma Non-helmeted motorcycle rider
- 5. CAT of Skull Fracture
- 6. Subarachnoid Hemorrhage Blood shows white on CT. Anterior Communicating Artery aneurysm has burst, flooding the basal structures under the brain outside the brain parenchyma, but will occasionally empty into a Ventricle as it has on the left here (see fluid level). Note typical “bat wing” shape just above the mid- brain (green arrow).
- 7. Coiling of anterior cerebral artery rupture and SAH Coil shown by green arrow. Note blood load on either side of the coil (red arrows) a high risk factor for cerebral artery spasm and stroke 5 - 8 days post bleed.
- 8. Severe Subarachnoid Hemorrhage Severe hemorrhage and probable clotting and obstruction at the 3rd ventricle and /or obstruction at the formena of Luschka and Magendie and 4th ventricle causing hydrocephalus. Poor outcome Likely.
- 9. Acute subdural with contusion and edema on left side Red arrow- acute blood between dura and brain. Green arrow- brain contusion with subarachnoid features. Brain bruise with bleeding into the subarachnoid space and into the parenchyma. Not the same as a burst aneurysm. Edema shows as shift of midline toward right side.
- 10. Chronic Subdural (Hygroma) with new contusion on left parietal If not resolved, acute subdural turns into chronic hygroma, consistency of crank case oil and shows black on CR (red arrow). New contusion with subarachnoid and parenchyma features shown by green arrow.
- 11. Previous Prefrontal lobotomy as young adult in 50s Performed by sticking lance shaped knife up into pre-frontal brain through thin bone over eyeball and swishing back and forth. Very effective in calming agitated patients most of whom assume Hillary Clinton-like smile permanently
- 12. Big bland stroke on right and craniotomy for decompression Other strokes progress to severe brain edema 3 - 5 days post stroke and require surgical decompression. Note cranium removed on right side to make room for brain edema. CT shows bland stroke as dark contrast. Temporal lobe is sometimes also removed on ipsalateral side to make room for edema. Humans can live normally with only one temporal lobe. If you lose both, you get “Memento”.
- 13. Stroke (post craniotomy for decompression) Big bland stroke on left, with craniotomy and replacement of skull fragment (green arrow).
- 15. Intraventricular bleed This was a young person who eventually went on to rehab (real rehab- not the kind Britney goes to) and back to school.
- 16. Normal MRI MRI shows alterations between water and fat content of tissues. Gives a high resolution view of brain, especially stroke, appearing as white contrast which sometimes can take as long as 8 hours to show up.
- 17. Strokes show up faster on MRI than CT
- 18. MRI and CAT views of the same whole R. hemispherical infarct Some very big strokes settle down and don’t require surgical decompression. This man opens his eyes to verbal on nasal cannula and follows on the right side 10 days post stroke.
- 19. Same bleed into brain stem on CT (right) and MRI (left)
- 20. “Normal” view of brain (MRI) The un-processed view of brain is obscured by CSF which lights up like a light bulb, obfuscating fine detail
- 21. T2 FLAIR negates CSF The T2 FLAIR view negates CSF, allowing a more accurate view of brain structure. However, the T2 shows most pathology in the brain as white and does not differentiate well between ischemia, tissue damage and bleeding.
- 22. New stroke on T2 FLAIR New strokes usually show up as white on T2.
- 23. MPGR shows accumulated blood Blood shows white on T2 Flair Left). black on MPGR (Right),
- 24. Old stroke Usually cystify and develop firm borders
- 26. Brain tumors: Glioblastoma Multiforme • Glios are rapid growing and cause death by brain compression. They do not usually metastasize, but occasionally can following debulking surgery.
- 27. Giant meningioma • Meningiomas are slow growing and have discrete borders. • Most amenable to operative resection.
- 28. MRI Side views: Chiari malformation Some believe cranium too small for brain, Others believe the foramen magnum is malformed. Symptoms of headache, ataxia and nystagmus with progressive pressure on brain stem.
- 29. Bi-temporal distribution is typical. Thought to occur by re-activation of herpes virus much like “cold sores” except through different nerve distribution Herpes encephalitis
- 30. Hydrocephalus
- 31. CT angio of giant unruptured MCA aneurysm
- 32. Persistent Vegetative State (Terry Schiavo) Severe atrophy of brain tissue
- 33. GOOD LUCK SAMIR EL ANSARY ICU PROFESSOR AIN SHAMS CAIRO elansarysamir@yahoo.com