CNs

1. CNS
2

2. • TRAUMA
• CEREBRAL VASCULAR DISEASE

3. TRAUMA
• A) skull fractures
• B) parenchymal injury
• C) vascular injury
• D) Sequelae of brain trauma
• E) Spinal cord injury

4. A) SKULL FRACTURES

7. B) PARENCHYMAL INJURIES

8. • PARENCHYMAL INJURIES
• i) Concussion
• ii) Direct parenchymal injury
• contusions
• laceration
• iii) Diffuse axonal injury

9. • i) Concussion
• clinical syndrome of altered consciousness due to head
injury
• transient neurological dysfunction
• loss of consciousness
• temporary respiratory arrest
• loss of reflexes
• complete neurological recovery
• repeated injuries=> post concussive neuropsychiatric
syndromes, chronic traumatic encephalopathy

10. • ii) Direct parenchymal injury
• contusion=> bruise
• laceration=> penetrating object, tearing of
tissue

12. • Coup injury vs Contrecoup injury
• blow to head with development of contusion
at contact point=> coup injury
• contusion on brain surface diametrically
opposite to point of contact=> contrecoup

13. • iii) Diffuse axonal injury
• deep white matter regions of brain may be
affected in traumatic injuries
• microscopy
• axonal swelling=> diffuse axonal injury
• focal hemorrhagic regions

15. C) TRAUMATIC VASCULAR INJURY

16. • results from direct trauma and disruption of
vessel wall
• leads to haemorrhage in different sites

18. • Hemorrhage may occur in the;
• epidural
• subdural
• sub arachnoid
• intra parenchymal components

21. with the dura retracted, the bridging
veins are stretched and revealed

22. • Subarachnoid
hemorrhage

23. Intra parenchymal hemorrhage

24. • D) Sequelae of brain trauma;
• post traumatic hydrocephalus
• chronic traumatic encephalopathy (CTE)
• dementing illness
• repeated head trauma
• post traumatic epilepsy, risk of infection,
psychiatric disorders

25. • E) SPINAL CORD INJURY
• level of injury determines neurological
symptoms and signs

26. • TRAUMA
• CEREBRAL VASCULAR DISEASE

27. CEREBRAL VASCULAR DISEASE

28. • STROKE
• Injury to the brain as a consequence of altered blood flow
• ischemic
• impaired blood supply and oxygenation
• embolus or thrombosis
• global or focal
• hemorrhagic
• rupture of CNS vessel or aneurysm
• hypertension
• vascular anomalies (aneurysms and
malformations)

30. • HYPERTENSIVE CEREBROVASCULAR DISEASE
• effects of hypertension on brain;
• lacunar infarcts
• slit haemorrhages
• hypertensive encephalopathy
• massive hypertensive intra cerebral hemorrhage

31. • HTN affects the deep penetrating arteries and arterioles that supply
the basal ganglia, hemispheric white matter and brain stem

32. • Lacunar infarcts
• arteriolar sclerosis as a complication of HTN
may occlude cerebral vessels
• results in single of multiple, small, cavitary
infarcts=> lacunes (<15mm wide)

34. • Slit hemorrhages
• rupture of small caliber penetrating vessels
• results in small hemorrhages
• resorption=> leaves slit-like cavity (slit
hemorrhages) surrounded by brownish
discolouration

36. • Intra parenchymal hemorrhage
• rapture of a small intra parenchymal vessel
• may be;
• ganglionic or lobar
• two major causes; hypertension and cerebral
amyloid angiopathy

37. • Massive hypertensive hemorrhage rupturing into
a lateral ventricle

38. • Cerebral amyloid angiopathy (CAA)
• is a risk factor most commonly associated
with lobar hemorrhages
• deposition of amyloidgenic peptides in
vessel wall can weaken them

39. • Amyloid deposition in a cortical arteriole in CAA;
insert=> immunohistochemical staining for A beta.

40. • SUBARACHNOID HEMORRHAGE AND RUPTURED
SACCULAR ANEURYSMS
• rupture of intra cerebral arteries which are the
primary branches of the circle of Willis
• saccular aneurysm is the most common type of
intracranial aneurysm
• other aneurysms
• atherosclerotic (fusiform, basilar artery)
• mycotic
• traumatic
• dissecting

43. • Clinical features of SAH?

44. end