NeuroradiologyKesha Desai

Inferior Surface of the brain

Superior Surface of the brain

Lateral Surface of the brain

Medial Surface of the Brain

Control Centers of the Brain

Neuroradiology ImagingCTBonesLow costFluid is darkAcute blood is brightMRISoft tissues/multiplanar/no radiationT2: Fluid is brightT1: Fluid is dark

White vs. Gray

CASE 132 yo F presented to the ED with a sudden acute onset headache that radiated down her neck. The headache was more intense and severe than the occasional migraine headaches that she experiences.

SAH

Circle of Willis

CASE 254 yo F who was grocery shopping noted right sided weakness and language deficits. In addition, she had homonymous hemaniopia with her eyes deviated towards the left.

Left MCA infarct

Middle Cerebral Artery

CASE 345 yo M had right sided LE flaccid paralysis followed by spastic weakness.

ACA infarct

Anterior Cerebral Artery

CASE 475 yo F brought to the ER because of an acute change in his mental status. She had reportedly fallen at home.

Subdural Hematoma

CASE 531 yo F is brought to the ER after being struck by a car. Initially, she was responsive but subsequently, she lost consciousness.

Epidural Hematoma

-Base of the frontal lobes, temporal lobes, and occipital lobes-Brain stem-Cerebellum

Superior surfaces of the frontal lobes, parietal lobes, and occipital lobes.Frontal Lobe: Voluntary movement, judgment, speechTemporal lobe: hearing, speech comprehensionParietal lobe: comprehension of language, object recognitionOccipital love: primary visual areaGray matter: covers the cerebral cortex, consists of neuron cell bodies /dendrites, site of actual processing (EPSPS/IPSPS). 40% brain is gray matter but it uses 94% of total oxygen supply to brain. White matter: consists of axons and associate mylein, white appearance due to high lipid content, site of signal transmission (APs). 60% of the brain is white matter.

High attenutating, amorphous substance that fills the normally dark CSF filled subarachnoid spaces around the brain. The normally black SA cisterns/sulci may appear white in acute hemorrhage. Blood in the subarachnoid space is usually the result of berry anuerysm rupture or AV malformations (kids). The majority of the aneurysms are located in the anterior circulation: at the junction of the internal carotid a. and posterior communicating a., the anterior communicating a. complex, or the trifurcation of the middle cerebral artery. Low attenutation abnormality of the left fronto-parietal lobe extending from the lateral ventricles to the brain surface. The MCA is the larger of the two terminal branches of the internal carotid artery. The other terminal branch is the ACA. The MCA supplies: - most of the lateral convexity of the brain surface-trunk, arm, and face areas of the motor/sensory cortices-Broca and Wernickes speech areas-Basal ganglia-anterior and posterior limbs of the internal capsuleLow attenuation abnormality involving the left frontal lobe. Mass effect is present with effacement of the overlying sulci. The anterior cerebral artery is the smaller of the two terminal branches of the internal carotid artery. It supplies the anterior 4/5 of the corpus callosum, and medial aspects of the frontal/parietal lobes. Supplies the leg and foot area of the motor and sensory cortices. High signal intensity of acute blood on the left side of the brain and midline shift of ventricle. Mechanism: stretching and tearing of bridging cortical veins in the subdural space due to a sudden change in velocity of the head. Can be acute or chronic. MR from acute subdural hematomas is very high (50-85%). High attenutation biconvex extraaxial fluid collection in the frontoparietal region on the right side of the brain. Associated mass effect is present with effacement of the cortical sulci. The overlying skull has a mildly depressed skull fracture. Mechanism: in 85-95% of patients, this is caused by a laceration of the middle meningeal artery or dural venous sinus by an overlying skull fracture.