NEURORADIOLOGY
Interhemispheric Fissure
\u2022
Hugely deep (down to the corpus callosum
\u2022
Divides brain into 2 hemispheres
Sylvian fissure
\u2022
Hugely deep
\u2022
Mostly horizontal
\u2022
Insula is buried within it
\u2022
Separates tempral lobe from parietal and
frontal lobes
Cingulate Sulcus
\u2022
Divides the gingulate gyrus from precuneus
and paracentral lobule
Central sulcus
Paracentral sulcus
Post central sulcus
Notes:
Diffusion weighted images (DWI): important in
increasing density in areas with acute infarct
MRI: depicts more of the brain anatomy (in that case,
better than CT)
Most common location of Hypertensive plane: area of
thalamus
STROKE
2 major types:
\u2022
Hemorrhagic stroke
a. Intracerebral: due to drugs like Coumadin
(warfarin) or due to thrombocytopenia
b. SAS: due to rupture of cerebral aneurysm as a result of hypertension bleed (affects basal ganglia) and amyloid coagulopathy
Pathognomonic of Coagulopathy: fluid
level with blood
SAS:
-
MCC is trauma
-
In absence of trauma: due to
cerebral
aneurysm
-
Manifestations:
severe
H/A,
seizure, LOC
-
Increase in density in area of
cistern
\u2022
Ischemic stroke
**Serpiginous: AV Malformation
HEMORRRHAGIC STROKE
\u2022
Are due to a rupture of a cerebral blood vessel
that causes bleeding into or around the brain
\u2022
Accounts for 16% of all strokes
\u2022
2 major categories of hemorrhagic stroke
o
Intracerebral hemorrhage
\u2013 the most common, accounts for 10%
of all strokes
o
Subarachnoid hemorrhage
\u2013 due to rupture of a cerebral aneurysm, accounts for 6% of strokes overall
Intracerebral Hemorrhage
\u2022
Causes
o
Hypertensive
hemorrhage-
most
common cause of non traumatic
intracerebral hematoma
o
Other causes: amyloid angiopathy- a
ruptured
vascular
malformation, coagulopathy, hemorrhage into a tumor, venous infection, and drug abuse
Hypertensive hemorrhage
\u2022
Often appears as a high density hemorrhage in
the region of the basal ganglia
\u2022
Blood may extend into the ventricular system
\u2022
Intraventricular extension of the hematoma is
associated with poor prognosis
\u2022
Commonly due to vasculopathy involving the
deep penetrating arteries of the brain
\u2022
Has a predilection for deep structures including the thalamus, pons, cerebellum, and basal ganglia\u2014particularly the putamen and external capsule
Coagulopathy related Intracerebral Hemorrhage
\u2022
Can be due to drugs such as Coumadin or a
systemic
abnormality
such
as
thrombocytopenia
\u2022
On imaging:
o
Heterogeneous appearance due to
completely clotted blood
o
A fluid level within a hematoma
suggests
coagulopathy
as
an
underlying mechanism
Hemorrhage due to Arteriovenous Malformation
\u2022
Underlying arteriovenous malformation (AVM) may or may not be visible on a Ct scan. However, prominent vessels adjacent to the hematoma suggest an underlying AVM. In addition, some AVM contains dysplastic areas of calcifications and may be visible as serpentine enhancing structures
Subarachnoid hemorrhage
\u2022
Most common cause- ruptured cerebral
aneurysm
\u2022
Cerebral aneurysms are frequently located
around the Circle of Willis
\u2022
Common aneurysm locations: ACoA, PCoA,
MCA bifurcation, tip of the basilar artery
\u2022
Typically presents as the \u201cworst headache of
life\u201d
\u2022
The re-hemorrhage rate of ruptured aneurysms
is high and often fatal
\u2022
On CT:
o
Appears as high density within sulci
and cisterns
o
The insular regions and basilar cisterns
o
May have associated intraventricular
hemorrhage and hydrocephalus
ISCHEMIC STROKE
\u2022
Caused by blockage of flow in a major cerebral
blood vessel due to a blood clot
\u2022
Account for about 84% of all strokes
\u2022
Further subdivided based on their etiology:
o
Thrombotic stroke
o
Embolic stroke
o
Lacunar stroke
o
Hypoperfusion infarction
Thrombotic Stroke
\u2022
Occurs when a blood clot forms in situ within a cerebral artery and blocks and reduces the flow of blood through the artery
\u2022
May be due to an underlying stenosis, rupture of an atherosclerotic plaque, hemorrhage within the wall of the blood vessel, or an underlying hypercoaguable state
\u2022
May be preceded by a transient ischemic
attack and often occurs at night or in the
morning when the blood pressure is low.
\u2022
Account for 53% of all strokes
Embolic stroke
\u2022
Occurs when a detached clot flows into and
blocks a cerebral artery
\u2022
The detached clot often originates from the heart or from the walls of large vessels such as the carotid arteries
\u2022
Atrial fibrillation is also a common cause
\u2022
Account for 30% of all strokes
Lacunar infarction
\u2022
Occurs when the walls of the small arteries
thicken
\u2022
Cause the occlusion of the artery
\u2022
Typically involve the small perforating vessels of the brain and result in lesions that are less than 1.5 cm in size
Hypoperfusion Infarction
\u2022
Occur under two circumstances
o
Global anoxia may occur from cardiac
or respiratory failure
o
Presents an ischemic challenge to the
brain
\u2022
Tissue downstream from a severe proximal stenosis of a cerebral artery may undergo a localized hypoperfusion infarction
CT findings of Stroke
\u2022
Presence or absence of hemorrhage
\u2022
Dense MCA or dense basilar artery
\u2022
Subtle changes of acute ischemia
o
Obscuration of the lentiform nuclei
o
Loss of insular ribbon
o
Loss of gray white distinction
o
Sulcal effacement
Notes:
Plain CT: can visualize hemorrhage of infarction
If shows dense basilar or MCA: signifies
infarction
Lentiform Nucleus Obscuration
\u2022
Due to cytotoxic edema in the basal ganglia
\u2022
This sign indicates proximal MCA occlusion, which results in limited flow to the lenticulostriate arteries
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Neuroradiology
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| Upload Date: | 02/20/2009 |
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