This document discusses craniovertebral anomalies and Arnold-Chiari malformations. It begins by defining the craniocervical junction and some common anomalies seen in India, like atlantoaxial dislocation. Diagnosis involves radiological lines and angles used to identify abnormalities. Chiari malformations are described as hindbrain herniations causing compression. Type I is most common and can cause symptoms through cord/medulla compression, cerebellar compression, and disrupted CSF flow. MRI is key for diagnosis. Management may involve conservative treatment or decompression surgery.
ECHOCARDIOGRAPHIC EVALUATION OF MITRAL VALVE DISEASEPraveen Nagula
MITRAL VALVE ANATOMY , M MODE FINDINGS IN MITRAL STENOSIS,EVALUATION OF THE SEVERITY OF LESION,CALCIFIC MS,CCMA,CONGENITAL LESIONS,GUIDELINES ALL IN DETAIL....
Mitral valve prolapse involves the superior displacement of one or both mitral valve leaflets into the left atrium. It has a prevalence of approximately 2% in the general population and occurs equally in males and females. Diagnosis is made through physical examination and 2D echocardiography, which shows a single or bi-leaflet prolapse of at least 2 mm beyond the annular plane. Mitral valve prolapse can be primary/nonsyndromic or secondary/syndromic as seen in conditions like Marfan syndrome. Treatment may involve surgery for more severe cases.
Rib notching refers to deformities of the superior or inferior rib surfaces and can be caused by a variety of conditions. Superior rib notching is often seen in osteogenesis imperfecta, rheumatoid arthritis, and SLE due to abnormal bone formation or resorption. Inferior rib notching, also called Roesler's sign, indicates enlarged collateral vessels and is seen in coarctation of the aorta, interrupted aortic arch, subclavian artery obstruction, and Takayasu arteritis. Both superior and inferior rib notching can occur in hyperparathyroidism due to increased osteoclastic activity from elevated parathyroid hormone levels.
This document outlines Dr. Sulav Pradhan's presentation on vascular territories of the brain and different types of strokes. It discusses the role of imaging modalities like CT, CT angiography, MRI, diffusion weighted imaging, and perfusion imaging in evaluating acute ischemic strokes. It describes the appearance of ischemic brain tissue on different sequences over time and how these modalities are used to distinguish irreversible infarcted tissue from potentially salvageable penumbra.
Case of 71 year old female, a retired school teacher from Camarines Sur, Philippines who complained of severe headache.
Diagnostic CT cerebral angiogram showed bilobulated aneurysm at the distal end of right ICA.
Cerebral aneurysms arise from focal degeneration of arterial walls. The most common type is saccular aneurysms, which protrude from arterial bifurcations and lack an internal elastic lamina. Aneurysms can present with subarachnoid hemorrhage, cranial nerve palsy, headache or seizures. Imaging plays a key role in diagnosing aneurysms and evaluating risks. Computed tomography best identifies acute subarachnoid hemorrhage but may miss small bleeds. Catheter angiography remains the gold standard for precise aneurysm characterization to guide treatment.
Non traumatic Subarachnoid hemorrhage (SAH)Milan Silwal
The document discusses imaging of non-traumatic subarachnoid hemorrhage (SAH). The most common cause of SAH is the rupture of a saccular aneurysm, usually located in the circle of Willis. CT and MRI are used to diagnose and locate SAH, while CT angiography, MR angiography, and conventional angiography can identify aneurysms. Complications of SAH like hydrocephalus and cerebral ischemia are also discussed. Perimesencephalic and convexal SAH represent patterns of non-aneurysmal SAH with different etiologies and prognoses.
ECHOCARDIOGRAPHIC EVALUATION OF MITRAL VALVE DISEASEPraveen Nagula
MITRAL VALVE ANATOMY , M MODE FINDINGS IN MITRAL STENOSIS,EVALUATION OF THE SEVERITY OF LESION,CALCIFIC MS,CCMA,CONGENITAL LESIONS,GUIDELINES ALL IN DETAIL....
Mitral valve prolapse involves the superior displacement of one or both mitral valve leaflets into the left atrium. It has a prevalence of approximately 2% in the general population and occurs equally in males and females. Diagnosis is made through physical examination and 2D echocardiography, which shows a single or bi-leaflet prolapse of at least 2 mm beyond the annular plane. Mitral valve prolapse can be primary/nonsyndromic or secondary/syndromic as seen in conditions like Marfan syndrome. Treatment may involve surgery for more severe cases.
Rib notching refers to deformities of the superior or inferior rib surfaces and can be caused by a variety of conditions. Superior rib notching is often seen in osteogenesis imperfecta, rheumatoid arthritis, and SLE due to abnormal bone formation or resorption. Inferior rib notching, also called Roesler's sign, indicates enlarged collateral vessels and is seen in coarctation of the aorta, interrupted aortic arch, subclavian artery obstruction, and Takayasu arteritis. Both superior and inferior rib notching can occur in hyperparathyroidism due to increased osteoclastic activity from elevated parathyroid hormone levels.
This document outlines Dr. Sulav Pradhan's presentation on vascular territories of the brain and different types of strokes. It discusses the role of imaging modalities like CT, CT angiography, MRI, diffusion weighted imaging, and perfusion imaging in evaluating acute ischemic strokes. It describes the appearance of ischemic brain tissue on different sequences over time and how these modalities are used to distinguish irreversible infarcted tissue from potentially salvageable penumbra.
Case of 71 year old female, a retired school teacher from Camarines Sur, Philippines who complained of severe headache.
Diagnostic CT cerebral angiogram showed bilobulated aneurysm at the distal end of right ICA.
Cerebral aneurysms arise from focal degeneration of arterial walls. The most common type is saccular aneurysms, which protrude from arterial bifurcations and lack an internal elastic lamina. Aneurysms can present with subarachnoid hemorrhage, cranial nerve palsy, headache or seizures. Imaging plays a key role in diagnosing aneurysms and evaluating risks. Computed tomography best identifies acute subarachnoid hemorrhage but may miss small bleeds. Catheter angiography remains the gold standard for precise aneurysm characterization to guide treatment.
Non traumatic Subarachnoid hemorrhage (SAH)Milan Silwal
The document discusses imaging of non-traumatic subarachnoid hemorrhage (SAH). The most common cause of SAH is the rupture of a saccular aneurysm, usually located in the circle of Willis. CT and MRI are used to diagnose and locate SAH, while CT angiography, MR angiography, and conventional angiography can identify aneurysms. Complications of SAH like hydrocephalus and cerebral ischemia are also discussed. Perimesencephalic and convexal SAH represent patterns of non-aneurysmal SAH with different etiologies and prognoses.
Full story brain herniation imaging Dr Ahmed EsawyAHMED ESAWY
Full story brain herniation imaging Dr Ahmed Esawy
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray images
I Supratentorial herniation
1-Cingulate (subfalcine/transfalcine)
2-Uncal (descending transtentorial herniation DTH)
3-Central (bilateral DTH)
4-Transcalvarial
5-Tectal (posterior)
II-Infratentorial herniation
1-Upward
(upward cerebellar or upward transtentorial)
2-Tonsillar (downward cerebellar
III-Sphenoid/alar herniation Transalar Herniation
This document discusses various types of primary cardiac tumors. It begins by stating that myxomas are the most common type of benign primary cardiac tumor, accounting for around 50% of cases. Myxomas most often originate in the left atrium. Papillary fibroelastomas are the second most common primary cardiac tumor, usually arising from heart valves. Rhabdomyomas are more common in pediatric patients under 1 year of age and often involve both ventricles. Echocardiography and MRI are useful imaging modalities for evaluating cardiac tumors.
This document discusses imaging findings and classifications of various types of intra-cranial vascular malformations. It describes key features of arteriovenous malformations (AVMs), cerebral proliferative angiopathy, and dural arteriovenous fistulas (dAVFs). AVMs appear on imaging as a tightly packed tangle of vessels with early draining veins. Cerebral proliferative angiopathy presents as a diffuse network of vessels interspersed with normal brain tissue. DAVFs involve abnormal shunting between meningeal arteries and dural venous sinuses.
Arteriography and interventional radiologyMilan Silwal
Angiography involves the radiologic examination of blood vessels after injection of iodinated contrast medium. Arteriography specifically examines arteries, while venography examines veins. Techniques include non-invasive ultrasound and MRI, minimally invasive CT or MRI with contrast, and invasive catheterization. Catheters and guide wires are used to access vessels and inject contrast medium. Potential complications include contrast reactions, embolism, infection, and vessel damage. Indications for arteriography include evaluating congenital anomalies, aneurysms, stenoses, arteritis, trauma, embolism, vascular malformations, fistulas, hemorrhage, and masses.
This document summarizes various heart diseases including coronary heart disease, stable angina, acute myocardial infarction, valvular heart diseases, and their appearances on chest radiographs. Coronary artery disease is caused by atherosclerosis and presents as coronary calcification or cardiomyopathy. Acute MI can cause pulmonary edema on CXR. Valvular diseases like aortic stenosis present with left ventricular hypertrophy and calcification while aortic regurgitation causes cardiomegaly. Mitral stenosis presents with left atrial enlargement and pulmonary hypertension.
This document provides an overview of how to systematically analyze a head CT scan. It begins with identifying patient information and scan parameters. It then describes how to examine different regions of the brain from midline structures outward, including ventricles, cisterns, brain parenchyma, sulci, sinuses, bones, and soft tissues. Key things to evaluate for in each region are discussed, such as midline shift, masses, hemorrhages, fractures, and more. Two case examples are then presented to demonstrate application of the approach.
380 Revascularization techniques for complex aneurysms and skull base tumorNeurosurgery Vajira
This document discusses revascularization techniques for complex aneurysms and skull base tumors. It covers when bypass is necessary due to inadequate collateral circulation, planning for bypass procedures, types of procedures including interposition grafts and direct arteriotomy, management during and after surgery, and complications. Revascularization techniques are used to treat complex aneurysms when coiling or clipping is not possible or to sacrifice arteries during tumor removal when normal blood flow must be restored. Careful planning and patient management are required due to risks of graft occlusion, hemorrhage, and ischemia.
This document discusses the surgical management of middle cerebral artery (MCA) aneurysms. Key points include:
- MCA aneurysms are most commonly located at the MCA bifurcation and trifurcation. They can grow quite large before detection and present challenges for endovascular treatment.
- Surgical preparation involves cerebrospinal fluid drainage and a pterional craniotomy for exposure. The Sylvian fissure is opened to access the aneurysm.
- For clipping, the aneurysm is dissected away from surrounding branches and temporarily clipped before applying definitive clips in parallel to branches to avoid remnants. Complex aneurysms may require multiple clips or fenestrated clips.
- Giant or fusiform
The patient presented with altered sensorium, decreased movement in their right side, and deviation of their mouth to the left. Imaging showed a non-hemorrhagic infarct in the left fronto-parietal region consistent with a stroke. An echocardiogram found left ventricular non-compaction (LVNC), a mobile clot attached to the left ventricle, and normal systolic function. The final diagnosis was LVNC, stroke, hyperhomocysteinemia, and hyperlipidemia. LVNC is a rare heart condition where the left ventricle fails to compact during development, leaving prominent trabeculations. It can cause heart failure, arrhythmias, and thromboemb
Coarctation of Aorta by Dr Kuntal SuranaKuntal Surana
This document provides information on coarctation of the aorta, including its definition, embryology, types, diagnosis, and surgical management. Coarctation of the aorta is a narrowing of the aorta beyond the level of the innominate artery. It can be caused by abnormal ductal tissue formation or reduced blood flow affecting development in utero. Types include preductal and postductal. Diagnosis involves imaging like echocardiogram, CT, or MRI to identify the narrowing. Surgical techniques to repair coarctation include resection with end-to-end anastomosis, prosthetic patch aortoplasty, and subclavian flap aortoplasty. Untreated coarctation
This document discusses the normal development of the brain from embryology through maturation. It then reviews various congenital brain lesions that can occur due to disruptions during different stages of development including dorsal induction, ventral induction, neuronal proliferation and migration, and myelination. Specific lesions discussed include holoprosencephaly, septo-optic dysplasia, schizencephaly, corpus callosum agenesis, arachnoid cysts, and more. Imaging findings for each condition are also provided.
The document discusses conduits used in coronary artery bypass grafting (CABG). It describes the history of CABG, beginning with Alexis Carrel's description in the early 1900s. It outlines the three eras of CABG and discusses key pioneers like Michael DeBakey and Rene Favaloro. The document then describes the different types of arterial and venous conduits used in CABG, focusing on the internal thoracic artery and radial artery. It discusses the anatomy, histology, harvesting techniques, and patency rates of different conduits.
This document summarizes the history and criteria for diagnosing left ventricular noncompaction (LVNC) via echocardiography. It describes the original 1990 criteria using X/Y ratios between trabeculations and recesses. Second 1999 criteria used a noncompacted to compacted myocardium ratio over 2.3. Later studies refined understanding. The latest 2014 criteria require all 4 criteria be met regarding prominent trabeculations, synchronous movement, two-layer structure, and perfusion of intertrabecular spaces. Echocardiography looks for a noncompaction to compaction ratio over 2 and more than 3 recesses communicating to the left ventricle in diastole. MRI diagnoses if noncompaction mass is
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.
A 33-year-old female patient presented with severe heart failure for one year and was previously diagnosed with dilated cardiomyopathy. She underwent cardiac imaging tests including echocardiography, ECG, and MSCT to rule out coronary artery disease. The echocardiography and MSCT revealed prominent trabeculations and a spongiform appearance of the left ventricle consistent with noncompaction cardiomyopathy. Noncompaction cardiomyopathy is a rare genetic heart condition characterized by excessive trabeculations and deep intratrabecular recesses in the left ventricle.
This document discusses Doppler ultrasound of the carotid arteries. It begins with an introduction describing how carotid artery disease can cause strokes and how ultrasound is used to diagnose stenosis to determine surgical candidates. It then describes the anatomy of the carotid arteries and outlines the normal ultrasound appearance. Key points of a carotid ultrasound exam are described including using grayscale, color Doppler, power Doppler and spectral analysis. Different types of carotid plaques are defined as well as how they appear ultrasonographically. Methods for evaluating stenosis and differentiating true from pseudo-spectral broadening are also covered.
Cross sectional anatomy of chest by Dr. MilanMilan Silwal
The document summarizes the anatomy of the chest cavity including boundaries, divisions of the mediastinum, and contents of each mediastinal compartment. It also describes seven specific levels used to analyze cross-sectional CT images of the chest based on characteristic anatomic landmarks seen at each level.
This document discusses diaphragmatic paralysis, including:
1. The diaphragm's role in respiration and how paralysis affects breathing physiology. Paralysis can range from being asymptomatic to respiratory insufficiency.
2. Causes of paralysis include neurological issues, trauma, infection, and surgery near the phrenic nerves. Unique causes include lupus and neck manipulation.
3. Symptoms depend on factors like severity, unilateral vs bilateral involvement, and pre-existing lung disease. Symptoms range from none to orthopnea, dyspnea, and hypoxemia at rest or with exercise.
This document discusses imaging of salivary gland pathologies. It begins with the anatomy of major and minor salivary glands. Common pathologies include sialolithiasis, acute and chronic sialadenitis, ranula, and various neoplasms. Imaging modalities like ultrasound, CT, MRI, and radionuclide studies are used to evaluate the glands. Ultrasound can identify stones, duct dilatation, and blood flow. CT and MRI accurately depict glandular anatomy and pathology. Sialography and MR sialography help in evaluating obstructive diseases. Both benign and malignant neoplasms can involve the salivary glands.
The document discusses craniovertebral junction anomalies including definitions, classifications of bony and soft tissue anomalies, Arnold-Chiari malformation types, clinical presentations, investigations, and treatments. Major anomalies discussed include platybasia, occipitalization, basilar invagination, dense dysplasia, atlanto-axial disease, Arnold-Chiari malformations, syringomyelia, and syringobulbia. Clinical features, investigations using MRI/CT, and surgical treatments are described for various conditions.
This document discusses various malformations of the posterior fossa, including Chiari malformations, Dandy-Walker malformation, Joubert syndrome, and Rhomboencephalosynapsis. It provides details on the anatomy and development of the posterior fossa. Chiari type 1 malformation is described as the most common, characterized by caudal descent of the cerebellar tonsils through the foramen magnum. Chiari type 2 malformation is associated with myelomeningocele and involves descent of the brainstem into the spinal canal through an abnormally small posterior fossa. Imaging and treatment options are discussed for evaluating and managing these posterior fossa malformations.
Full story brain herniation imaging Dr Ahmed EsawyAHMED ESAWY
Full story brain herniation imaging Dr Ahmed Esawy
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray images
I Supratentorial herniation
1-Cingulate (subfalcine/transfalcine)
2-Uncal (descending transtentorial herniation DTH)
3-Central (bilateral DTH)
4-Transcalvarial
5-Tectal (posterior)
II-Infratentorial herniation
1-Upward
(upward cerebellar or upward transtentorial)
2-Tonsillar (downward cerebellar
III-Sphenoid/alar herniation Transalar Herniation
This document discusses various types of primary cardiac tumors. It begins by stating that myxomas are the most common type of benign primary cardiac tumor, accounting for around 50% of cases. Myxomas most often originate in the left atrium. Papillary fibroelastomas are the second most common primary cardiac tumor, usually arising from heart valves. Rhabdomyomas are more common in pediatric patients under 1 year of age and often involve both ventricles. Echocardiography and MRI are useful imaging modalities for evaluating cardiac tumors.
This document discusses imaging findings and classifications of various types of intra-cranial vascular malformations. It describes key features of arteriovenous malformations (AVMs), cerebral proliferative angiopathy, and dural arteriovenous fistulas (dAVFs). AVMs appear on imaging as a tightly packed tangle of vessels with early draining veins. Cerebral proliferative angiopathy presents as a diffuse network of vessels interspersed with normal brain tissue. DAVFs involve abnormal shunting between meningeal arteries and dural venous sinuses.
Arteriography and interventional radiologyMilan Silwal
Angiography involves the radiologic examination of blood vessels after injection of iodinated contrast medium. Arteriography specifically examines arteries, while venography examines veins. Techniques include non-invasive ultrasound and MRI, minimally invasive CT or MRI with contrast, and invasive catheterization. Catheters and guide wires are used to access vessels and inject contrast medium. Potential complications include contrast reactions, embolism, infection, and vessel damage. Indications for arteriography include evaluating congenital anomalies, aneurysms, stenoses, arteritis, trauma, embolism, vascular malformations, fistulas, hemorrhage, and masses.
This document summarizes various heart diseases including coronary heart disease, stable angina, acute myocardial infarction, valvular heart diseases, and their appearances on chest radiographs. Coronary artery disease is caused by atherosclerosis and presents as coronary calcification or cardiomyopathy. Acute MI can cause pulmonary edema on CXR. Valvular diseases like aortic stenosis present with left ventricular hypertrophy and calcification while aortic regurgitation causes cardiomegaly. Mitral stenosis presents with left atrial enlargement and pulmonary hypertension.
This document provides an overview of how to systematically analyze a head CT scan. It begins with identifying patient information and scan parameters. It then describes how to examine different regions of the brain from midline structures outward, including ventricles, cisterns, brain parenchyma, sulci, sinuses, bones, and soft tissues. Key things to evaluate for in each region are discussed, such as midline shift, masses, hemorrhages, fractures, and more. Two case examples are then presented to demonstrate application of the approach.
380 Revascularization techniques for complex aneurysms and skull base tumorNeurosurgery Vajira
This document discusses revascularization techniques for complex aneurysms and skull base tumors. It covers when bypass is necessary due to inadequate collateral circulation, planning for bypass procedures, types of procedures including interposition grafts and direct arteriotomy, management during and after surgery, and complications. Revascularization techniques are used to treat complex aneurysms when coiling or clipping is not possible or to sacrifice arteries during tumor removal when normal blood flow must be restored. Careful planning and patient management are required due to risks of graft occlusion, hemorrhage, and ischemia.
This document discusses the surgical management of middle cerebral artery (MCA) aneurysms. Key points include:
- MCA aneurysms are most commonly located at the MCA bifurcation and trifurcation. They can grow quite large before detection and present challenges for endovascular treatment.
- Surgical preparation involves cerebrospinal fluid drainage and a pterional craniotomy for exposure. The Sylvian fissure is opened to access the aneurysm.
- For clipping, the aneurysm is dissected away from surrounding branches and temporarily clipped before applying definitive clips in parallel to branches to avoid remnants. Complex aneurysms may require multiple clips or fenestrated clips.
- Giant or fusiform
The patient presented with altered sensorium, decreased movement in their right side, and deviation of their mouth to the left. Imaging showed a non-hemorrhagic infarct in the left fronto-parietal region consistent with a stroke. An echocardiogram found left ventricular non-compaction (LVNC), a mobile clot attached to the left ventricle, and normal systolic function. The final diagnosis was LVNC, stroke, hyperhomocysteinemia, and hyperlipidemia. LVNC is a rare heart condition where the left ventricle fails to compact during development, leaving prominent trabeculations. It can cause heart failure, arrhythmias, and thromboemb
Coarctation of Aorta by Dr Kuntal SuranaKuntal Surana
This document provides information on coarctation of the aorta, including its definition, embryology, types, diagnosis, and surgical management. Coarctation of the aorta is a narrowing of the aorta beyond the level of the innominate artery. It can be caused by abnormal ductal tissue formation or reduced blood flow affecting development in utero. Types include preductal and postductal. Diagnosis involves imaging like echocardiogram, CT, or MRI to identify the narrowing. Surgical techniques to repair coarctation include resection with end-to-end anastomosis, prosthetic patch aortoplasty, and subclavian flap aortoplasty. Untreated coarctation
This document discusses the normal development of the brain from embryology through maturation. It then reviews various congenital brain lesions that can occur due to disruptions during different stages of development including dorsal induction, ventral induction, neuronal proliferation and migration, and myelination. Specific lesions discussed include holoprosencephaly, septo-optic dysplasia, schizencephaly, corpus callosum agenesis, arachnoid cysts, and more. Imaging findings for each condition are also provided.
The document discusses conduits used in coronary artery bypass grafting (CABG). It describes the history of CABG, beginning with Alexis Carrel's description in the early 1900s. It outlines the three eras of CABG and discusses key pioneers like Michael DeBakey and Rene Favaloro. The document then describes the different types of arterial and venous conduits used in CABG, focusing on the internal thoracic artery and radial artery. It discusses the anatomy, histology, harvesting techniques, and patency rates of different conduits.
This document summarizes the history and criteria for diagnosing left ventricular noncompaction (LVNC) via echocardiography. It describes the original 1990 criteria using X/Y ratios between trabeculations and recesses. Second 1999 criteria used a noncompacted to compacted myocardium ratio over 2.3. Later studies refined understanding. The latest 2014 criteria require all 4 criteria be met regarding prominent trabeculations, synchronous movement, two-layer structure, and perfusion of intertrabecular spaces. Echocardiography looks for a noncompaction to compaction ratio over 2 and more than 3 recesses communicating to the left ventricle in diastole. MRI diagnoses if noncompaction mass is
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.
A 33-year-old female patient presented with severe heart failure for one year and was previously diagnosed with dilated cardiomyopathy. She underwent cardiac imaging tests including echocardiography, ECG, and MSCT to rule out coronary artery disease. The echocardiography and MSCT revealed prominent trabeculations and a spongiform appearance of the left ventricle consistent with noncompaction cardiomyopathy. Noncompaction cardiomyopathy is a rare genetic heart condition characterized by excessive trabeculations and deep intratrabecular recesses in the left ventricle.
This document discusses Doppler ultrasound of the carotid arteries. It begins with an introduction describing how carotid artery disease can cause strokes and how ultrasound is used to diagnose stenosis to determine surgical candidates. It then describes the anatomy of the carotid arteries and outlines the normal ultrasound appearance. Key points of a carotid ultrasound exam are described including using grayscale, color Doppler, power Doppler and spectral analysis. Different types of carotid plaques are defined as well as how they appear ultrasonographically. Methods for evaluating stenosis and differentiating true from pseudo-spectral broadening are also covered.
Cross sectional anatomy of chest by Dr. MilanMilan Silwal
The document summarizes the anatomy of the chest cavity including boundaries, divisions of the mediastinum, and contents of each mediastinal compartment. It also describes seven specific levels used to analyze cross-sectional CT images of the chest based on characteristic anatomic landmarks seen at each level.
This document discusses diaphragmatic paralysis, including:
1. The diaphragm's role in respiration and how paralysis affects breathing physiology. Paralysis can range from being asymptomatic to respiratory insufficiency.
2. Causes of paralysis include neurological issues, trauma, infection, and surgery near the phrenic nerves. Unique causes include lupus and neck manipulation.
3. Symptoms depend on factors like severity, unilateral vs bilateral involvement, and pre-existing lung disease. Symptoms range from none to orthopnea, dyspnea, and hypoxemia at rest or with exercise.
This document discusses imaging of salivary gland pathologies. It begins with the anatomy of major and minor salivary glands. Common pathologies include sialolithiasis, acute and chronic sialadenitis, ranula, and various neoplasms. Imaging modalities like ultrasound, CT, MRI, and radionuclide studies are used to evaluate the glands. Ultrasound can identify stones, duct dilatation, and blood flow. CT and MRI accurately depict glandular anatomy and pathology. Sialography and MR sialography help in evaluating obstructive diseases. Both benign and malignant neoplasms can involve the salivary glands.
The document discusses craniovertebral junction anomalies including definitions, classifications of bony and soft tissue anomalies, Arnold-Chiari malformation types, clinical presentations, investigations, and treatments. Major anomalies discussed include platybasia, occipitalization, basilar invagination, dense dysplasia, atlanto-axial disease, Arnold-Chiari malformations, syringomyelia, and syringobulbia. Clinical features, investigations using MRI/CT, and surgical treatments are described for various conditions.
This document discusses various malformations of the posterior fossa, including Chiari malformations, Dandy-Walker malformation, Joubert syndrome, and Rhomboencephalosynapsis. It provides details on the anatomy and development of the posterior fossa. Chiari type 1 malformation is described as the most common, characterized by caudal descent of the cerebellar tonsils through the foramen magnum. Chiari type 2 malformation is associated with myelomeningocele and involves descent of the brainstem into the spinal canal through an abnormally small posterior fossa. Imaging and treatment options are discussed for evaluating and managing these posterior fossa malformations.
chiari or arnold chiari malformations, various types and pathophysiology, radiological and clinical presentation of the types, signs symptoms, investigations and treatment of these malformations both conservative and surgical. considerations and controversiies in management of chiari malformation associated with various conditions.
Lecture occipital cervical fusion for rheumatoid arthritisSpiro Antoniades
Dr. Smith
Anesthesia: Dr. Jones
Procedure:
The patient was brought to the OR in supine position, prepped and draped in the usual sterile fashion. A midline incision was made from the inion to C7. Subperiosteal dissection was performed down to the occiput and C7. Lateral fluoroscopy was used to identify the appropriate levels. A high-speed burr was used to perform a laminectomy from C1 through C6. Pedicle screws were placed bilaterally at C2, C3, C4, C5, C6 and C7 under fluoroscopic guidance. Occipital screws were placed bilaterally under the superior n
Neurocutaneous syndromes involve abnormalities of both the skin and central nervous system. This document summarizes several key neurocutaneous syndromes including tuberous sclerosis complex, neurofibromatosis type 1, and Sturge-Weber syndrome. Tuberous sclerosis complex is characterized by benign tumors in multiple organ systems and features such as facial angiofibromas and hypomelanotic macules. Neurofibromatosis type 1 causes cafe-au-lait spots and benign nerve tumors known as neurofibromas. Sturge-Weber syndrome is associated with a port-wine stain of the face and leptomeningeal angiomas of the brain.
This document provides an overview of syringomyelia, including:
- It is a spinal cord cavity filled with cerebrospinal fluid, with a prevalence of 9 per 100,000 people.
- It can be caused by traumatic injury, Chiari malformation, or other craniovertebral junction anomalies.
- Symptoms depend on the location and extent of the syrinx and can include sensory loss, weakness, pain, and autonomic dysfunction.
- Magnetic resonance imaging is the best way to diagnose and assess syringomyelia.
- Treatment may involve surgery to decompress the craniovertebral junction, open the syrinx, or place a shunt
Disorders of neural tube closure and neuronal migrationdrnaveent
This document discusses various neural tube closure disorders and disorders of neural migration during embryonic development. It provides an overview of embryology and describes specific disorders including anencephaly, spina bifida, callosal dysgenesis, Dandy-Walker malformation, Joubert syndrome, holoprosencephaly, heterotopic gray matter, lissencephaly, schizencephaly, hemimegalencephaly, and polymicrogyria. For each disorder it discusses features on imaging and clinical presentations.
The craniovertebral junction refers to the occiput, atlas, and axis vertebrae and their articulations and ligaments. It is a complex anatomical region forming the transition between the skull and cervical spine. Common craniovertebral junction anomalies include occipitalization of the atlas, basilar invagination, atlantoaxial dislocation, and dens dysplasia. These anomalies can be developmental, post-traumatic, or acquired. Imaging studies including X-rays, CT, MRI are used to classify and evaluate the anomalies. Treatment may involve surgery such as fusion if the anomaly causes spinal cord compression.
Spina bifida is a birth defect where the spine and spinal cord do not form properly. It occurs when the neural tube fails to close fully during early embryonic development. The most common type is myelomeningocele, where parts of the spinal cord and meninges protrude out of an opening in the spine. This can cause paralysis, loss of feeling, and problems with bladder and bowel control below the level of the defect. Treatment involves surgery to close the opening and manage any related complications like hydrocephalus. Prevention focuses on adequate folic acid intake before and during early pregnancy.
This document discusses birth injuries, including definitions, risk factors, types, and descriptions of specific injuries. Some key points:
- Birth injuries occur in about 0.7% of births and account for under 2% of neonatal deaths. Factors like difficult delivery or fetal positioning can increase risk.
- Types of injuries include head/neck trauma, nerve injuries, fractures, and internal organ damage. Specific injuries discussed include brachial plexus injuries, skull fractures, intracranial hemorrhages, and others.
- Injuries are described in detail, along with typical presentations, diagnostic methods, and treatment approaches depending on severity. Head injuries commonly involve skull fractures or bleeding, while nerve injuries often affect the
Congenital malformations of the brain abdul finalabduljelil nejmu
This document provides an overview of congenital malformations of the brain. It discusses normal brain development and then covers various types of malformations including disorders of neurulation (neural tube defects like anencephaly and cephaloceles), disorders of regionalization (holoprosencephaly, septo-optic dysplasia, corpus callosum dysgenesis, and Dandy-Walker malformation), and Chiari malformations (types I-III and variants). For each type of malformation, the document describes key imaging features, clinical presentation, associated conditions, and differential diagnosis.
This document provides an overview of diseases of the spinal cord including symptoms, signs, and specific syndromes associated with lesions at different spinal cord levels. It discusses both compressive and non-compressive myelopathies. Compressive causes include tumors, abscesses, hematomas, and herniated disks. Non-compressive causes include infarction, autoimmune disorders, infections, and demyelinating diseases. Chronic myelopathies such as spondylosis, vascular malformations, and nutritional deficiencies are also reviewed. The document provides detailed information on localizing spinal cord lesions and distinguishing features of various spinal cord syndromes.
Syringomyelia is a condition where a cyst, called a syrinx, develops in the spinal cord. It most commonly affects the lower cervical spine. It is often associated with abnormalities of the skull or spinal column. The majority of cases are linked to Chiari malformation type 1, where the cerebellar tonsils are displaced into the spinal canal. Symptoms vary depending on the location of the syrinx but can include pain, loss of sensation, muscle weakness or atrophy, and autonomic dysfunction. Diagnosis is made using imaging like MRI. Treatment involves surgery to decompress pressure on the spinal cord like laminectomy with the goal of resolving the syrinx.
This document discusses various types of birth injuries that can occur in infants. It describes soft tissue injuries, skull injuries like cephalohematomas and fractures, and intracranial hemorrhages. It also covers facial injuries like subconjunctival hemorrhages and brachial plexus injuries. Risk factors for birth injuries include primiparity, fetal macrosomia, and mechanical forces during delivery. Diagnosis involves physical examination, imaging, and assessment of neurologic function. Management depends on the type and severity of injury but may include wound care, splinting, ventilation support, or surgery.
Neural tube defects are among the most common human malformations, occurring in approximately 1-5 per 1,000 live births. They result from the failure of the neural tube to close properly during early embryonic development. There are several types of neural tube defects including anencephaly, encephalocele, spina bifida, and myelomeningocele. Folic acid supplementation before and during early pregnancy has been shown to significantly reduce the risk of neural tube defects.
1. Congenital hemivertebrae occur due to failure of somite formation during embryonic development and can cause spinal curvature or neurological problems by narrowing the spinal canal.
2. Tethered cord syndrome occurs when the spinal cord is attached at the caudal end, most commonly due to defective degeneration of the caudal cell mass.
3. Conditions that can lead to tethered cord include lipomyelomeningocele, diastematomyelia, anterior sacral meningocele, and dermal sinus, which may require surgical intervention such as laminectomy and cord release to prevent neurological problems.
Craniofacial Microsomia and Hemifacial AtrophySatish Kumar
Craniofacial microsomia involves congenital malformations of structures arising from the first and second branchial arches. It can cause deformities of the orbit, mandible, ear, nerves and soft tissues that range from mild to severe. The etiology is unclear but may involve vascular perturbations, teratogen exposure or neural crest pathology. Treatment involves surgery to correct deformities such as mandibular distraction, commissuroplasty or facial reanimation procedures.
Cervical myelopathy is caused by compression of the cervical spinal cord, most commonly from cervical spondylosis. Cervical spondylosis involves degenerative changes to the spine that decrease space for the spinal cord. This can lead to static or dynamic compression of the cord, impairing circulation. Patients experience symptoms like neck pain, weakness, spasticity and sensory changes. Diagnosis involves assessing severity using scales and investigating spinal changes through imaging like CT which shows stenosis and compression more clearly than x-rays.
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3. • Atlantoaxial dislocation, occipitalisation of atlas, and fusion of C2
and C3 vertebrae are the commonest anomalies occurring in India.
• Males are most commonly affected and a predisposing factor like
trivial neck trauma may be identified in nearly 50% of the cases.
• The signs and symptoms of these anomalies are diverse that include
local radicular Neck pain, high cervical cord compression, lower
cranial nerves palsy and cerebellar involvement.
• The clinical manifestations are often delayed into the second and
third decade because they are usually subtle
5. • Lines and angles used in radiologic diagnosis of C.V
junction anomalies.
1) CHAMBERLAIN’S LINE
• Extends from the posterior margin of the hard palate to the
posterior margin of the foramen magnum (opisthion).
• The tip of the odontoid process normally lies below or just tangent to
the Chamberlain’s line.
• The odontoid projecting above this line is diagnostic of “basilar
invagination”.
7. 3) BASAL ANGLE
• Formed by the intersection of nasion– midsella and midsella–basion
tangents.
• The average angle is 134–135° with a minimum of 121° and a
maximum of 148–149°.
• An abnormally obtuse angle is the best indication of platybasia or
flattening of the skull base.
• it is frequently associated with basilar invagination.
20. • Chiari type I malformation is the most common and the least severe
of the spectrum, often diagnosed in adulthood.
• Its hallmark is caudal displacement of peglike cerebellar tonsil below
the level of the foramen magnum referred to as congenital tonsillar
herniation, tonsillar ectopia, or tonsillar descent.
• The resultant impaction of the foramen magnum, compression of the
cervicomedullary junction by the ectopic tonsils, and interruption of
normal flow of cerebrospinal fluid (CSF) through the region produce
the clinical syndrome.
22. Characteristic Chiari I Chiari II
Usual age of diagnosis Adults and older children Infants and young children
Clinical findings
• Headache and neck pain (worsened by cough or Valsalva
maneuver)
• Myelopathy
• Cerebellar symptoms
• Lower brainstem symptoms (eg, dysarthria, dysphagia,
downbeat nystagmus)
• Central cord symptoms (eg, hand weakness, dissociated
sensory loss, cape anesthesia)
• In infants, signs of brainstem dysfunction predominate:
swallowing/feeding difficulties, stridor, apnea, weak cry,
nystagmus
• Weakness of extremities
23. Primary anatomical abnormalities
• Herniation of cerebellar tonsils through foramen magnum,
producing compression of cervicomedullary junction
• Herniation of lower brainstem through foramen magnum
• Kinking of cervicomedullary junction
• "Beaking" of tectum
• Upward herniation of vermis through incisura
• Nearly vertical tentorium
Myelomeningocele No Always
Hydrocephalus Less than 10% of cases Very common
Syringomyelia 30-70% Common
Associated abnormalities
• Craniocervical hypermobility syndromes
• Klippel-Feil anomaly
• Hereditary connective tissue disorders and neurofibromatosis
type II
• Callosum corpus pellucidum septum of agenesis
• Hypoplasia or
• Enlargement of massa intermedia
• Heterotopias and gyral abnormalities
Shared associated abnormalities
• Basilar invagination
• Occipitalization of atlas
• Bifida of C1 posterior arch
• Foramen magnum variant anatomy
• Basilar invagination
• Occipitalization of atlas
• Bifida of C1 posterior arch
• Foramen magnum variant anatomy
24. • Chiari malformation type I, hypothesized to be a disorder of para-axial
mesoderm, which subsequently results in formation of a small
posterior fossa.
• The development of the cerebellum within this small compartment
results in overcrowding of the posterior fossa, herniation of the
cerebellar tonsils, and impaction of the foramen magnum.
• The greater incidence of Chiari I and II in females supports the view
that posterior fossa size is genetically determined, with males having
larger posterior fossa spaces than females, so that restriction of
posterior fossa size leads to hindbrain herniation more readily in
females than males.
30. •MANAGEMENT
• Patients with Chiari I malformations who have minimal symptoms
without syringomyelia can be treated conservatively.
• Mild neck pain and headaches can be treated with analgesics, muscle
relaxants, and occasional use of a soft collar.
• Frankly symptomatic patients should be offered surgical treatment.
• The goals of surgical treatment are decompression of
cervicomedullary junction and restoration of normal CSF flow in the
region of foramen magnum.
36. CLINICAL FEATURES
• Syringomyelia usually progresses slowly; the course may extend over
many years.
• Symptomatic presentation depends primarily on the location of the
lesion within the neuraxis.
• Syrinx interrupts the decussating spinothalamic fibers that mediate
pain and temperature sensibility, resulting in loss of these sensations,
while light touch, vibration, and position senses are preserved
(dissociated sensory loss).
• When the cavity enlarges to involve the posterior columns, position
and vibration senses in the feet are lost.
42. • Goel further classified basilar invagination into two categories based
on the anatomical inclination of odontoid process and clivus.
• In group A basilar invagination, there was a ‘fixed’ atlantoaxial
dislocation and the tip of the odontoid process ‘invaginated’ into the
foramen magnum and was above the Chamberlain line, McRae line of
foramen magnum and Wackenheim’s clival line.
• In group B, patients had normally inclined odontoid process and clivus
and the tip of the odontoid process was above Chamberlain’s line but
below McRae’s and Wackenheim’s lines.
46. • The atlantoaxial instability has been traditionally gauzed by the
atlantodental interval that signifies the abnormal movement of the
odontoid process away from the circle of atlas and toward the neural
structures in the spinal canal.
• The indentation of the odontoid process into the critical cervicomedullary
neural structures result in related symptoms.
• Such instability, also called as the type 1 atlanto-axial instabilty is the more
common form of atlantoaxial dislocation.
• Type 2 atlantoaxial instability, wherein the facets of atlas are dislocated
posterior to the facet of axis on lateral CT images.
47. Also classified as
1) Lateral atlantoaxial facetal dislocation is when the facet of the atlas is
dislocated lateral in relationship with the facet of axis.
2) Vertical atlantoaxial dislocation is when the odontoid process migrates
superiorly on flexion of the head and returns back entirely or incompletely
to normal position on head extension.
3) Rotatory atlantoaxial dislocation is when the facet of the atlas is dislocated
posterior in relationship with the facet of axis on one side and anterior in
its relationship on the contralateral side.
Such a dislocation results in torticollis.
4) Translatory atlantoaxial dislocation is a clinical situation when the facets
of atlas of both sides are dislocated anterior to the facets of axis.
51. • Feil, in 1919, described KFS into 3 groups according to degree of
involvement
• Type I- Massive fusion of many of the cervical and upper thoracic
vertebrae.
• Type II- the fusion at one or two interspaces with occipitoatlantoid
fusion, hemivertebrae or other abnormalities in the cervical spine ,
and
• Type III- cervical fusion in combination with lower thoracic or lumbar
fusion.