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Radiology of Brain hemorrhage vs infarction


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this presentaion is free for every medical student
by the end of this presentation you will be able to identify cerebral strokes and determine the age of the pathology
good luck .. Dr Thamir alotaify

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Radiology of Brain hemorrhage vs infarction

  1. 1. Brain hemorrhage Vs infarction in CT and MRI Thamir Diab Alotaify 4th year – medical student NBU – medical college
  2. 2. Objectives • • • • • Types of cerebral strokes and etiology CT and MRI in cerebral hemorrhage CT and MRI in cerebral infarction 4-min Vedio for learning purpose Conclusion
  3. 3. Intracrainial hemorrhage Def / active bleeding inside the cranial cavity Types : - Epideural - Subdeural - Subarachnoid - Intracerebral (intraparnchymal) - Intraventricular
  4. 4. Etiology • Generally most common cause of ICHs are traumatic causes • And the most common cause of such traumas are RTAs • Always it is nessery to evaluate the head and neck after RTAs Clinically +++ radiologically Even if the patient is Asymptomaic(lucid interval )
  5. 5. CT and MRI in ICH • CT scan is the modality of choice in traumatic head injuries ( in ER) • Why ? - Rapid - It can shows the bone status - It can detect the early onset of hemorrhge • So the CT good for 3 Bs -Blood -Brain -Bone
  6. 6. Stages of brain hemorrhage in CT • Acute : hyperdense • Sub acute : isodense • Chronic : hypodense
  7. 7. CT appearance of hemorrhage. Serial CT scans of right thalamic hematoma. (A) Acute ICH in the right thalamus with mean attenuation 65 HU. (B) CT performed 8 days later than (A); the periphery of the hematoma is now isodense to the brain while the center of the hematoma has mean attenuation 45 HU. (C) CT performed 13 days later than (A) shows continued evolution of the hematoma with decreasing attenuation. (D) CT performed 5 months later than (A) shows a small area of encephalomalacia in
  8. 8. ICH in MRI • MRI is not a best choice for urgent diagnosis , it takes time and may be not available , and not good for bone status (not usefull in acute head injury ) • But it is the best modality for brain paranchymal assessment ( infarcts, demyelinatind dis , Tumors )
  9. 9. Brain infarction • • • • • Def/ necrosis of brain tissue due to many causes types : (global , focal) Most common cause : ischemia Other causes : Metabolic : hypoglycemia Toxic : drugs Cerebral infarction it can be detected in both CT & MRI • CT may appear normal in hyperacute state ( <3h) • MRI can detect small infarction at the moment
  10. 10. Cerebral infarction on CT • • • • - Hyperacute : before 3houres of onset ..normal Early acute (4-6) : Chronic : (>3days) Dense MCA sign Obscuration of the lenticular nucleus -Well demarcated hypodensity insular ribbon Sign Simillar density to CSF Late acute : --ve mass effect (pulled midline) -Dilataion of ventricles Low density basalganglia (Encephalomalacia ) sulcal effacement Subacute : Increasing mass effect Wedge-shaped low density area involving gray and white matter Possible hemorrhagic transformation
  11. 11. Early acute (3-6 ) MCA sign
  12. 12. Subacute cerebral infarction Marked ill defined hypodense area involving most of the RT cerebral hemisphere and shifting the midline
  13. 13. Chronic cerebral infarction Massive Hypodense area in LT cerebral hemispher Simillar density of CSF + ipsilateral widening of lateral ventricle
  14. 14. Cerebral infarction in MRI +ve DWI
  15. 15. Imaging Findings of Stroke: Acute Stroke (up to 7 days) • MR imaging of the brain is far more sensitive than CT imaging to recognize acute infarction. • Diffusion wtd. pulse sequence (DW imaging) is the most sensitive MR sequence to demonstrate stroke. This sequence is sensitive to restricted diffusion within the cell from stroke-induced cytotoxic edema and the region of acute stroke is seen as an area of bright signal on DWI Cytotoxic edema can occur immediately after the initial insult thus DWI images can reveal, the area of acute infarct immediately after the insult. • Intravascular contrast enhancement, another sign of early stroke (Figure 1f). • Sulcal effacement, gyral edema (Fig. 5b), loss of gray-white matter interface can occur within 12 hours of stroke. • Parenchymal contrast enhancement (Fig. 6d), mass effect (Fig. 4b) and hemorrhage can occur within 1-7 days of insult. Subacute infarct: (1 week to 8 weeks) • Contrast enhancement slowly decreases in time but can persist for 8 weeks, with decreasing mass effect and abnormal signal intensity: Old Infarct: •Focal area of encephalomalacia •Porencephalic dilatation of adjacent ventricle. • Residual old blood products may be present.
  16. 16. conclusion • There are sequence of events in cerebral strokes : - Hyperacute - Acute - Subacute - Chronic • CT is best for hemorrhagic • MRI is best to detect the ischemic at the onset