Blok Brain and Mind 1

7/31/2019 Blok Brain and Mind 1

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Dr Hj Asmah Yusuf Sp.RadDr Evo Elidar Hrp Sp.Rad


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The Skull

The standard projections are :

1. The lateral view

2. The AP view


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Routine method of study of Skull

Xray

Examine : the inner and outer table

Examine trabeculasi and densitas bone

Examine: Sutures Examine :Vascular markings

Examine : sella

Examine : intracranial kalsifikasi


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Normal intracranial kalsifikasi

1.Pineal

2.Habenula

3.Choroid plexus

4.Dura (falx,tentorium).

5.Ligaments (petroclinoid and interclinoid)

6.Pacchionian bodies

7.Basal ganglia and dentate nuclei

8.Pituitary gland

9.Lens


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Normal Skull Films

AP Skull-X Ray Lateral Skull-X Ray


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AP view


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Lateral view


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Abnormal Skull

1.Fracture.

2.Metastasis3.Congenital disorders

4.Kalsifikasi

5.Raised intracranial pressure


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Metastasis

Lesi lytik


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Lesi lytik luas


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Multiple Myeloma


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Congenital disorders

Scaphocephaly


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Scaphocephaly


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Scaphocephaly


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Raised intracranial pressure

Hydrocephalus


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Raised intracranial pressure


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Computed tomography


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CT schematic


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INDIKASI HEAD SCAN

1.TRAUMA KEPALA

2.KELAINAN CEREBROVASCULER

3.TUMOR OTAK

4.KELAINAN KONGENITAL

5.PENYAKIT INFEKSI

6.ATROFI CEREBRAL ATAU

PENYAKIT-PENYAKIT

DEGENERATIF


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THE BRAIN LAYER ANATOMY

SKIN

BONE

EPIDURAL

DURAMATER

SUBDURAL

ARACHNOID

SUBARACHNOID PIAMATER


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T

H

E

B

R

A

I

N

LA

Y

E

R

AN

A

T

O

M

Y


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ANATOMY BRAIN


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HEAD Scan NORMAL


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FRAKTUR KEPALA

-DIHUBUNGKAN DG PENUMOCEPHALY

(udara didalam kepala) jarang

tension pneumocephalus

- Significan jika Fx terbuka berhub dg

udara luar merusak penampilan

(secara kosmetik penampilan tdk baik)

or


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berhubungan udara pd sinus resiko infeksi atau mudah

timbul perdarahan

(epidural hematom)-Treatment: hanya u kosmetikAtau pencegahan infeksi

( jika fx terbuka berhub dgudara luar atau udara padasinus


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Fracture


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Intracranial Hemorrhage

Intracranial hemorrhage can be classified

according to the space occupied by the

blood:

Epidural Hemorrhage

Subdural Hemorrhage

Subarachnoid Hemorrhage

Intraparenchymal Hemorrhage

Intraventricular Hemorrhage


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Intracranial Hemorrhage:

Types


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Epidural Hemorrhage

Between skull and dura, limited by

periosteal layer so stops at sutures of

skull and thus biconvex (lens) shaped

Due to middle meningeal arterytear,often associated with skull fracture


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E

P

ID

U

R

A

L

H

E

MA

T

O

M


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Subdural Hematoma

Occur in the 4 As : alcoholic,anti-

coagulant-treated,aged and abuse victims(shaken baby syndrome)

Between dura and archnoid of brain

Follow contour of brain so Crescent Shape.

Due to cortical bridging vein tear ashemoglobin broken down,blood changes color

on CT scan and can be easily mised(see sub acute )


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Usually patients with subdural

hematoma have worseinjury than epidural

hematoma

Small size bleeds can bespontaneusly absorbed by the

body,but ifmidline shift is

present

Surgical evacuation


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Subdural Hemorrhage

ACUTE SUB ACUTE CHRONIC


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Subarachnoid Hemorrhage

Subarachnoid hemorrhage is

generallyfeathery in appearance

on CT scan, as itsmixed in with

cerebrospinal fluid


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The MOST COMMON cause of

subarachnoid haemorrhage is1.Trauma2.The 2 nd and 3 rd most

common causes areaneurysms or arteriovenousmalformations

No intervention is generallyperformed for subarachnoidhemorrhage alone.


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However ,subarachnoidhemorrhage can causehydrocephalus (due toobstruction of CSF flow)or vasospasm (due to ?blood product irritating avessel) in delayed fashion


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S

A

H


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SA

H


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Intraparenchymal Hemorrhage

Called Contusions in trauma

bruising of the brain

Coup ( direct injury of brain impact) or

contrecoup (injury due to brain

hitting skull opposite side as skull

decelerates but brain doesnt)-usualy

temporal/frontal.


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-Can develop extreme amount

of edema or blossom,so mustfollow closely with repeat CTscans

-Can be caused byhypertensive hemorrhage incharacteristic locations(basal ganglia,thalamus pons,

cerebellum) or arteriovenousmalformations


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-In older patients (> 60 )

can be caused bycerebral amyloidangiopathy, usually in

a lobar location-Surgical evacuation ifexcessive mass effect


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Intraparenchymal

hemorrhage


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Intraventricular Hemorrhage

-Usually due to extension of

intraparenchymal bleed (most

Commonly from hypertension

-Treatment depends on whether

hydrocephalus developsthen

patients may need ventriculostomy

placement


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Intraventricular

hemorrhage


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STROKE

Stroke is disease

cerebrovasculer (venous of

brain) which marked with deathtissue brain (infarct cerebral)

happened because the less of

oxygen and blood strem tobrain.


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Stroke divided to become twotype

1.Stroke ischaemi bloodstream to brain is desisted byartherosclerotic (heaping ofcholesterol at venous wall) orblood clot which have corkingan vein to brain

2.Stroke hemorrhage venous

broken causing pursue normalblood stream and blood seepinto area brain in the

breakdown


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Cerebral infarct


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Infarct pons


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Cerebral hemorrhage


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Hydrocephalus

Normal CSF flow is from lateral

ventricles to third ventricle, via

aquaduct silvii to fourth V, then

through foramina of

magendieand luschka to

subarachnoid space,then

absorption via arachnoid

granulations into the superior

sagittal sinus


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-Any obstruction on this pathway

can cause hydrocephalus-Treatment is temporarily bydiverting spinal fluid via

ventriculostomy catheterpermanently,a shunt ( e.g.ventriculoperitoneal , or VP

shunt)


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H

YD

R

O

CE

P

H

AL

U

S


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BRAIN TUMOURS


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BRAIN TUMOURS


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Brain Tu (pylocytic astrocytoma)


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Brain tumors


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Cerebral abscess

Pada kontras tampak ring enhancement


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Encephalitis


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OLEH : Dr Hj. Asmah Yusuf Sp.RadDr. Elidar Hrp Sp.Rad

MRI


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MRIBeda CT scan VS MRI

CT MRIBiaya Mahal Sangat mahal

P.Rad sedang - tinggi (-)

Prinsip X-ray Magnet &

gel radioWaktu Biasa +/- 5 mnt +/- 30 mnt

Soft tissue tidak baik sangat baik

Tulang Baik tidak baik

Perub-imag (-) images beberapapotongan potongan


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MRI : Normal brain (axial)


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MRI : Normal brain (sagital)


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MRI : normal brain (coronal)


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MRI ( T 1 and T2)


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MRI VS CT

Encephalitis :11(MRI) 3 (CT)Infarct Acute : 82 % 58 %

CT : -Beberpa jam pertama normalpada : 60 % pasien walau klinis

sdh ada

-Scan ulang 48 jam setelah stroke area hypodense ( dark)


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MRI lebih sensitif dibanding CT,

Beberaoa menit setelah klinis /symptonGambaran MRI (+)

Cerebral Infarct


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Cerebral Infarct

CT T1 MRI T2 MRI


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Cerebral infract

Encephalitis


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Encephalitis

h li i


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Encephalitis

S b h id h h


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Subarachnoid hemorrhage

B i ( i l)


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Brain tumor (sagital)

MRI B i


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MRI : Brain tumor

D d W lk lf i


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Dandy Walker malformation

Chi i M lf i II


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Chiari Malformation type II


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