 Review the anatomy of the skull

 Review the anatomy of the brain and

intracranial vessels
 Illustrate and identify structures of the brain
on CT and MRI scans
I. Skull vault and Sutures
II. Skull base
III. Major Components of the Brain
IV. Scalp
V. Meninges
VI. Brain Parenchyma
VII. CSF Spaces—Ventricles and Cisterns
VIII.Blood Supply
IX. Venous Drainage
1. Conventional Radiography -Skull
radiographs, in general, are rapidly
becoming obsolete, being replaced by much
more sensitive CT scans.
 Skull X-ray
 X-ray of the Vertebral Spine
2. CT Scan
3. MRI
4. Ultrasound
5. Catheter Angiography
 SKULL XRAY  MRI BRAIN
 diagnosis of fracture  multi-sequence, multi-planar
 are still performed, but are study
being used less and less  different sequences allow
assessment of different
 CT HEAD things
 first line investigation for  no radiation
head trauma -to guide risk  long study - patient needs to
stratification and stay still
management
 more claustrophobic than a
▪ 3D reconstruction
CT
 assessment for intracranial
injury, e.g. haemorrhage
 useful in acute stroke
▪ check for acute haemorrhage
▪ often normal in the acute phase
 CRANIUM

 FACIAL SKELETON
 ethmoid
 lacrimal,
 nasal,
 zygomatic,
 maxilla)
 and mandible
 superior aspect of the
skull
 Encloses the brain
 DIVISION:
▪ Calvarium (roof)
▪ cranial base
 SKULL VAULT
 SKULL BASE
• FRONTAL BONE
• PARIETAL BONE
• SPHENOID BONE
• TEMPORAL BONE
• OCCIPITAL BONE
 Anterior cranial
fossa: Depression of skull
formed by frontal, ethmoid
and sphenoid bones.
 Middle cranial
fossa: Depression formed by
sphenoid, temporal and
parietal bones.
 Posterior cranial
fossa: Depression formed by
squamous and mastoid
temporal bone, plus occipital
bone.
 Coronal suture
 fuses the frontal bone with the
two parietal bones.
 Sagittal suture
 fuses both parietal bones to each
other
 Lambdoid suture
 fuses the occipital bone to the two
parietal bones.
In neonates, the incompletely fused
suture joints give rise to membranous
gaps between the bones, known as
fontanelles. The two major fontanelles
are the frontal fontanelle (located at
the junction of the coronal and
sagittal sutures) and the occipital
fontanelle (located at the junction of
the sagittal and lambdoid sutures).
 The pterion: a ‘H-shaped’ junction between temporal, parietal, frontal and
sphenoid bones. The thinnest part of the skull. A fracture here can lacerate an
underlying artery (the middle meningeal artery), resulting in a extradural
haematoma.
 Zygomatic - cheek
bones of the face, and
articulates with the
frontal, sphenoid,
temporal and maxilla
bones.
 Lacrimal - smallest
bones , medial wall of
the orbit.
 Nasal – 2 slender
bones, bridge of the
nose
 Inferior nasal conchae
- within the nasal cavity
 Palatine - rear of oral
cavity, part of the hard
palate
 Maxilla - part of the upper
jaw and hard palate
 Vomer -posterior aspect of
the nasal septum.
 Mandible (jaw bone) –
Articulates with the base
of the cranium at
the temporomandibular
joint (TMJ).
 non-angled
 provides an overview of the entire skull
 Patient position: erect, forehead is placed
against the image detector , nose in
contact
 the innominate lines should be equal
distance from the lateral borders of the
orbits
 decreases the radiation dose to the eyes
compared with the AP view
 less magnification of the facial bones
compared with the AP view
 overlap of facial bone structures ; difficult
to evaluate the sinuses
 petrous ridge will overlap the lower 1/3 of
the orbits
 provides an overview of the entire skull
 nonangled AP radiograph of the skull.
 Patient position: back of patient's head
is placed against the image detector
 the petrous ridge will overlap the lower
1/3 of the orbits
 may be necessary in patients who cannot
be easily or quickly rotated into the skull
PA view
 Disadvantages:
 overlap of facial bone structures makes it
harder to evaluate the sinuses than with
an angled view (e.g. Caldwell view)
 increases the radiation dose to the eyes
compared with the PA view
 increased magnification of the facial
bones compared with the PA view
 better visualise the paranasal sinuses,
especially the frontal sinus.
 Patient position: patient is seated in front
of the upright detector; forehead and nose
are both touching the detector
 centring point: angled caudad around 15°
to exit at the nasion
 orbitomeatal line is running perpendicular
to the detector
 petrous ridge is below orbits
 no rotation evident via the symmetrical
nature of the orbits
 the innominate lines should be equidistant
from the lateral borders of the orbits
 no tilting should be evident; an imaginary
line through the petrous ridges should be
horizontal
 Practical points - always guarantee that the
patient is not 'hunched' over when they are
being examined. This can cause an artefact
from the shoulders and the patient is more
likely to be rotated;
 nonangled lateral radiograph
 provides an overview of the
entire skull
 Patient position: sagittal
midline of the patient's head
is parallel to the image
detector
 sella turcica in profile
 temporomandibular
joints are superimposed
 X-ray beam features :beam
travels laterally, with 0° of
angulation, through a point
~4 cm above the external
auditory meatus
 occipitomental (OM)
 angled PA radiograph of
the skull, with the patient gazing
slightly upwards
 X-ray beam is angled at 45° to
the orbitomeatal line
 better view of the maxillary
sinuses.
 assess for facial fractures, as well
as for acute sinusitis (Maxillary,
Frontal Ethmoidal cells and
Sphenoid sinuses
”through open mouth”)
 Odontoid process (if it is just
below the mentum, it confirms
adequate extension of the head)
 angled AP radiograph of the skull.
 Patient position: patient's nuchal
ridge is placed against the image
detector
 dorsum sella overlies the foramen
magnum
 X-ray beam features: beam travels
anterior to posterior direction, with
~30-40° of angulation from ~5 cm
above the level of
the nasion, toward the foramen
magnum
 Advantages:
 occipital bone and posterior fossa
space better evaluated
 dorsum sellae & posterior clinoid
processes seen in the foramen
magnum
 POSITION: Supine
 REFERENCE POINT: Midportion of
the open mouth
 CENTRAL RAY: Perpendiculaly
directed
 EVALUATION CRITERIA:
Atlas and axis seen projected through
open mouth
Odontoid process and C1-C2
articulation
Upper teeth and base of skull
superimposed just above C1 level.
• sagittal suture

• lambdoid suture

• frontal sinus

• roof of the orbit

• ethmoid sinus

• maxilla

• mandible

• angle of the mandible

• mental protuberance
• coronal suture

• frontal sinus

• cribriform plate

• ethmoid sinus

• Pituitary fossa

• lambdoid suture

• sphenoid sinus

• zygomatic bone (lateral

wall of orbit)

• maxillary sinus

• mandible
 coronal
suture

parietal
bone
Frontal
bone

Lambdoid
suture

occipital
bone
 PARIETAL BONE
 SAGITTAL SUTURE
 LAMBDOID SUTURE
 OCCIPITAL BONE
 SKULL VAULT AND SUTURES

1-Frontal Bone
2-Coronal Suture
3-Parietal Bone
4-Lambdoid Suture
5-Occipital Bone
1. Ethmoid bone
2. Orbital part of frontal
bone
3. Sphenoid Bone
4. Temporal Bone
5. Parietal Bone 1
6. Occipital Bone 3

6
 Upper third
 Frontal sinuses
 Frontal recesses
 Ethmoid air cells
 Orbital roofs
 Ethmoid roofs
 Middle third or midface
 Zygomatic bone
 Maxillary bone
 Temporal bone
 Frontal bone
 Sphenoid bone
▪ Pterygoid process
 Lower third
 Mandible
 Zygomaticomaxillary
suture (malar eminence)
 Zygomaticotemporal
suture
 Zygomaticofrontal suture
 Zygomaticosphenoid
suture
 Temporal root of the
zygomatic arch
AXIAL
Inferior orbital foramen
 *
*
 orbit

Zygomatic
bone

Maxillary
sinus
 Condylar
 Subcondylar
 Coronoid process
 Ramus
 Angle
 Body
 Symphysis
1.DURA MATER
 Periosteal layer
 Meningeal layer
2. ARACHNOID MATER
3. PIA MATER

 EXTRADURAL
SPACE/EPIDURAL
SPACE
 SUBDURAL SPACE
 SUBARACHNOID
SPACE
 Dura mater

Periosteal layer

Meningeal layer

They are closely

united except
along certain lines;
they are separated
to form venous
sinuses
Subdural space

Coronal section of the upper part of the head

EPIDURAL SUBDURAL SUBARACHNOID
HEMATOMA HEMATOMA HEMORRHAGE
1. Falx Cerebri
2. Tentorium Cerebelli
3. Falx Cerebelli
 A midline sheet of dura
that lies in the
interhemispheric fissure
 Separates the right and
left cerebral
hemispheres.
 Anteriorly attached to
and arises from the bony
spur and midline surface
of the cribriform plate—
the CRISTA GALLI to the
internal occipital
protuberance
posteriorly.
 crescent-shaped fold of dura
mater that roofs over the
posterior cranial fossa.
 covers the upper surface of
the cerebellum and supports
the occipital lobes of the
cerebral hemispheres.
 Structures medial to the line
of the tentorial edge are in
infratentorial compartments
 Structures lateral to the
tentorial edge are in the
supratentorial compartment
 small, sickle-shaped
fold of dura mater
attached to the
internal occipital crest
and projects forward
between the two
cerebellar
hemispheres.
 Its posterior fixed
margin contains the
occipital sinus
 Parietal lobe

Occipital lobe
Temporal lobe
http://faculty.washington.edu/chudler/lobe.html
5 LOBES: 3
1. FRONTAL LOBE
2. PARIETAL LOBE
3. TEMPORAL LOBE
4. OCCIPITAL LOBE
5. INSULA
 A.TELENCEPHALON
I.FOREBRAIN- Cerebral Hemispheres (Cerebrum)
A. Cerebral Hemispheres
1. Gray Matter (Cerebral Cortex)
prosencephalon 1.Gray Matter
2. White Matter (Deep Gray Nuclei)
(Cerebral Cortex)
3. Basal Ganglia
2.White Matter
a. Caudate Nucleus
(Deep Nuclei)
b. Lentiform Nucleus
B. Diencephalon
• Globus Pallidus
1.Thalamus
• Putamen
2. Hypothalamus
B. Diencephalon
1. Thalamus
B 2. Hypothalamus
R 3. Epithalamus (Pineal gland)
A
A. Mesencephalon
II. MIDBRAIN I
N • Quadrigeminal Plate
S • Cerebral Peduncles
T
A. PONS - metencephalon
III.HINDBRAIN- E
M B. MEDULLA - myelencephalon
C. CEREBELLUM -metencephalon
rhombencephalon
  Divided into lobes by
four important sulci:
1. Lateral Sulcus
(Sylvian Fissure)
2. Central Sulcus
(Rolandic Fissure)
3. Parieto-occipital
sulcus
4. Calcarine Sulcus
AXIAL CORONAL SAGITTALL
AXIAL
CORONAL
SAGITTAL
TOP (Superior)

BOTTOM (Inferior)
BONE SOFT WATER FAT AIR
TISSUES
ATTENUATION VALUES (Hounsfield Units )
+1000 BONES

+100 CLOTTED BLOOD hyperdense

+60 UNCLOTTED BLOOD
+40 GRAY MATTER
+24 WHITE MATTER isodense
+5 CSF
0 WATER
-100 FAT

hypodense

-1000 AIR
 Bright Densities
 Dark Densities

Findings are always described based in relative

“densities” (vs MRI “intensity”)
 Calcium containing
structures
(e.g. bone)
 Blood
 Contrast material
 Air (sinuses, mastoid air
cells)
 Fluid (ventricles, sulci,
cisterns, fissures)
 Fat (myelin)
Myelin=FAT= Dark on CT
 T1-weighted signal
 T2-wieghted signal
 FAT is BRIGHT
 Fluid is Dark
 Ca++ no signal
 FLUID is BRIGHT
 FAT is Dark
 Ca++ no signal
World War II
“ Water is BRIGHT on T2”
 CT MR T1 MR T2
BONE BRIGHT DARK DARK
AIR DARK DARK DARK
FAT DARK BRIGHT DARK
WATER DARK DARK BRIGHT
BRAIN INTERMEDIATE Gray matter = GREY INTERMEDIATE
White matter = WHITE
PRECENTRAL CENTRAL POSTCENTRAL

PARIETO-OCCIPITAL
1. GRAY MATTER (Cerebral Cortex)
• Contains mainly nerve cell bodies
• Responsible for "higher-order" functions
like language and information
processing, memory, language,
abstraction, creativity, judgment,
emotion and attention.
• Involved in the synthesis of movements
2. WHITE MATTER
(Deep gray nuclei)
• Made up predominantly of nerve fibers
(axons) that transmits signal or Gray MAtter
information from one side of the
cerebral hemispheres to the other and
also transmits signal from the cerebral
hemispheres to the brain stem and vice White Matter
versa
3. BASAL GANGLIA
White matter

Grey matter
 Caudate nucleus (CN)
 Globus Pallidus (GP)
 Putamen (P)
 Thalamus (T)
 Internal Capsule (IC)
 External Capsule (EC)
 LN = GP + P (Lentiform nucleus = Globus
Nucleus + Putamen)
 BG = LN + CN (Basal Ganglia = lentiform
nucleus + Caudate Nucleus)
 group of nuclei in the deep white matter of the brain
 interconnected with the cerebral cortex, thalami and brainstem.
 contains three paired nuclei that together comprise the corpus striatum:
 caudate nucleus
 Putamen
 Globus pallidus (together with the putamen known as the lentiform nucleus)
CORPUS CALLOSUM
1. Genu
2. Body
3. Splenium

INTERNAL CAPSULE
1. Anterior Limb
2. Posterior Limb
3. Genu
B
S
G
 The basal ganglia are a group of nuclei in
the deep white matter of the brain that is
interconnected with the cerebral
cortex, thalami and brainstem.
 In a strict anatomical sense, it contains
three paired nuclei that together
comprise the corpus striatum:
 caudate nucleus
 putamen
 globus pallidus (together with the
putamen known as the lentiform nucleus)
 Functionally, two additional nuclei are
also part of the basal ganglia:
 subthalamic nuclei
 substantia nigra
 behaviors or "habits,” eye movements,
and cognitive, emotional functions
FH

ICCN
LN
T 3
CORPUS CALLOSUM EXTERNAL CAPSULE

INTERNAL CAPSULE
CAUDATE NUCLEUS THALAMUS

LENTIFORM NUCLEUS
 CN
p CN
GP p
GP

T
T

T1 T2
Corona Radiata

Internal Capsule

Cerebral Peduncle
 DIENCEPHALON

A. THALAMUS
 large ovoid gray mass
located on each side of
the 3rd ventricle
 correlate important
processes including
consciousness, sleep,
and sensory
interpretation.
 T

2. EPITHALAMUS 3.
(PINEAL GLAND) HYPOTHALAMUS
 midbrain (mesencephalon)
 pons (part of the metencephalon)
 medulla oblongata (myelencephalon)
 BRAINSTEM

MIDBRAIN PONS
 BRAINSTEM
MEDULLA CEREBELLUM
 F

T T
pons
4

Cerebellum
3

P 4 Cb
 F F

T pons
T

Cerebellum
 ACA

MCA
 FH

IC IC
CN

LN
3rd

T
 R
A
CD
O I
RA
OT
NA
A
CS CS
MB
MB MB
MB

P
T1

T1 T2
T1 T2
T1 T2
T1 T2
T1 T2
T1 T2
T1 T2
mb
pons
pons

md
T1 T2
T1 T2
T1 T2
 Frontal bone

Frontal Frontal
lobe Interhemispheric fissure lobe

Corona
Parietal radiata Parietal
lobe lobe
Lateral
ventricle

occipital bone
T1 T2
 Frontal bone

Head of caudate
Frontal nucleus Frontal
lobe lobe
Frontal horn
- lateral
ventricle

Parietal putamen Parietal lobe

lobe
thalamus
temporal lobe
temporal
lobe
posterior
horn -lateral
ventricle
Occipital Occipital
lobe parietooccipital lobe
sulcus
T1 T2
Frontal bone

Falx cerebri

Caudate head

Internal
capsule
(ant. Limb)
putamen

thalamus

Pineal
gland
T1 T2
T1 T2
 Interhemispheric
fissure
Frontal Frontal
Sylvian
lobe lobe
fissure

Pituitary
stalk Temporal
Temporal
lobe
lobe Cerebral
peduncle

Cerebellar
hemisphere
Temporal
lobe

Basilar
artery

Pons

4th
ventricle

Cerebellar
hemisphere

Confluence
of sinuses
T1 T2
 Basal Nuclei &
White Matter Tracts
MOTOR HOMONCULUS
 primary brain vesicles
rhombencephalon mesencephalon prosencephalon

pontine flexure Mesencephalon deepening groove

Myelencephalon Diencephalon

Metencephalon Telencephalon
 By about the third week of development, the nervous
system consists of a tube closed at both ends
 In its cavity is the neural canal that gives rise to the
ventricles of the adult brain and the central canal of the
spinal cord.
 The choroid plexus, which secretes the CSF that fills
the ventricles and the subarachnoid space, arises from
tufts of cells that appear in the wall of each ventricle
during the first trimester.
 By about the end of the first trimester, the
choroid plexus is functional, the openings in
the fourth ventricle are patent, and there is
circulation of CSF through the ventricular
system and into the subarachnoid space.
 As the hemispheres develop they create the
flattened "C" with a short tail shape of the
lateral ventricles that is present by birth .

 The lateral ventricle consists of an anterior

horn, a body, and posterior and inferior horns
 The junction of the body with the posterior and inferior horns
constitutes the atrium of the lateral ventricle.
 The glomus (a large clump of choroid plexus) is found in the atrium
 In adults and especially in elderly persons, the glomus may contain
calcifications that are visible on CT scans
 Shifts in the position of the glomus, usually accompanied by
alterations in the volume or shape of the surrounding ventricle, may
indicate some type of ongoing pathologic process or space-occupying
lesion.
 The anterior horn and body
of the lateral ventricle are
bordered:
1. Medially: by the septum
pellucidum (at rostral levels)
and the fornix (at caudal
levels)
2. Posteriorly: (superiorly) by
the corpus callosum
 The inter-ventricular foramina of Monro are
located between the column of the fornix
and the rostral and medial end of the
thalamus.

 There are two interventricular foramina, one

opening from each lateral ventricle into the
single midline third ventricle
 The third ventricle, the cavity
of the diencephalon, is a
narrow, vertically oriented
midline space that
communicates rostrally with
the lateral ventricles and
caudally with the cerebral
aqueduct

 The third ventricle has an

elaborate profile on a sagittal
view & is quite narrow in the
coronal and axial planes
 The cerebral aqueduct communicates rostrally with the third ventricle
and caudally with the fourth ventricle
 This midline channel is about 1.5 mm in diameter in adults and
contains no choroid plexus.
 Its susceptible to occlusion (triventricular hydrocephalus). For
example, cellular debris in the ventricular system (from infections or
hemorrhage) may clog the aqueduct. Tumors in the area of the
midbrain (such as pinealoma) may compress the midbrain and
occlude the aqueduct.
 The cerebral aqueduct is surrounded on all sides by a sleeve of gray
matter that contains primarily small neurons; this is the
periaqueductal gray or central gray.
 The boundaries of the third ventricle are formed by the dorsal
thalamus and hypothalamus, and recesses (supraoptic, infundibular,
pineal, suprapineal).
 The rostral wall of the third ventricle is formed by a short segment of
the anterior commissure and a thin membrane, the lamina terminalis,
 The floor of the third ventricle is formed by the optic chiasm and
infundibulum and their corresponding recesses, plus a line extending
caudally along the rostral aspect of the midbrain to the cerebral
aqueduct.
 The caudal wall is formed by the posterior commissure and the
recesses related to the pineal, whereas the roof is the tela choroidea,
from which the choroid plexus is suspended
 The only openings between the ventricles of the brain
and the subarachnoid space surrounding the brain are
the foramina of Luschka and Magendie in the fourth
ventricle.
 It opens into the area of the pons-medulla-cerebellum
junction, the cerebellopontine angle, through the
foramina of Luschka
 The irregularly shaped foramen of Magendie is located in
the caudal sloping roof of the ventricle
LV 3 4 SAS

FM AS FL&FM

C
SULCI,
CISTERNS
& FISSURES

LV 3 4
CSF CSF CSF

BRAIN

CSF SAS
 LV 3 4 SAS

CHOROID PLEXUS
CHOROID PLEXUS
ss

Sella Turcica
mb
 A
Basilar
B Cistern

Ventricle Size Cisterns

Make sure no hydrocephalus Should be plenty of CSF
- Evans ratio (A/B) < 0.3 (Black space)
Also check temporal horns No blood/compression
LV 3 4 SAS
 Brain receives 20% of the cardiac output.
 Major arterial supply via:
Internal carotids:
Give off paired anterior cerebral arteries.
Give off paired middle cerebral arteries.
Vertebral arteries:
Join to form unpaired basilar artery
 Arises from common carotid
artery in the neck
 Enter the skull base via the
carotid canal
 terminates at bifurcation
into the anterior cerebral
artery and middle cerebral
artery
 extracranial segment - origin
of the ICA to the skull base
 intracranial segment -divided
into petrous, cavernous,
supraclinoid portions
 major branches that arise
from the internal carotid
artery
 anterior and middle cerebral
arteries (anterior circulation
that supplies the forebrain)
 lenticulostriate arteries -
supply the basal ganglia
and thalamus
 The arrangement of the brain's arteries into
the Circle of Willis creates collaterals in the
cerebral circulation
 If one part of the circle becomes blocked or
narrowed (stenosed) or one of the arteries
supplying the circle is blocked or narrowed,
blood flow from the other blood vessels can
often preserve the cerebral perfusion well
enough to avoid the symptoms of ischemia
 They branch from the
subclavian arteries
 Enter deep to the transverse
process of the level of the C6
 Then proceed superiorly, in
the transverse foramen of
each cervical vertebra until
C1
 At the C1 level, the vertebral
arteries travel across the
posterior arch of the atlas
through the suboccipital
triangle before entering the
foramen magnum
 The posterior circulation of
the brain supplies the
posterior cortex, the
midbrain, and the brainstem
 Comprises arterial branches
arising from the posterior
cerebral, basilar, and
vertebral arteries
 Midline arteries supply
medial structures, lateral
arteries supply the lateral
brainstem, and dorsal-lateral
arteries supply dorsal-lateral
brainstem structures and the
cerebellum
 Superior cerebellar
artery (SCA) from
basilar artery
 Anterior inferior
cerebellar artery
(AICA) from basilar
artery
 Posterior inferior
cerebellar artery
(PICA) from vertebral
artery
three longitudinal arteries :
 anterior spinal artery
 right posterior spinal arteries
 and left posterior spinal arteries
 Found within the subarachnoid space and
send branches into the spinal cord
 form anastamoses via the anterior and
posterior segmental medullary arteries
 Supply blood up to cervical segments
 posterior and anterior radicular arteries –
supplies the lower cervical region ; run into
spinal cord alongside the dorsal and ventral
nerve roots
 intercostal and lumbar radicular arteries -arise
from the aorta ; major anastomoses and act as
blood flow supplement
 artery of Adamkiewicz – Largest anterior
radicular arteries ; arises between L1 and L2;
injury = spinal cord infarction and paraplegia
 Branches of vertebral arteries.
 To:
Dorsolateral part of medulla
Posterior choroid plexus
Posterior/inferior parts of cerebellum
 Form unpaired anterior spinal artery.
 Form basilar artery.
 Anterior inferior cerebellar artery
To upper medulla and pons
 Internal auditory artery
To part of inner ear
 Pontine arteries
To pons
 Superior cerebellar artery
 Terminate as posterior cerebral arteries
 Terminal branches of basilar artery.
 To:
Medial and inferior surfaces of the temporal
and occipital lobes, posterior thalamus.
 Occlusion results in thalamic syndrome:
 Contralateral diminishing of general somatic
modalities in head (ventral posterior nucleus).
 Threshold for pain, temperature, and tactile
sensation on contralateral side of head
raised.
 Mild stimuli may produce disagreeable
sensations.
 Largest branches of internal carotid arteries.
 Run between temporal and frontal lobes.
 To most of lateral surfaces of cerebrum.
 Give off striate arteries:
To internal capsule and adjacent structures.
Stroke:
Contralateral upper motor-neuron paralysis of
face and UE/LE as well as sensory
disturbances.
 Branches of internal carotid arteries.
 Give off perforating arteries to
hypothalamus.
 Extend rostrally and then curve upwards and
backwards around corpus callosum:
Pericallosal arteries
 Occlusion:
Contralateral paresis and diminished sensitivity
in LE.
 Interconnects vertebral and internal carotid
supply.
 Components:
Posterior cerebral arteries
Posterior communicating arteries
Internal carotids
Anterior cerebral arteries
Anterior communicating artery
 Border zones of cerebral arteries.
 Decreased blood supply.
 Hypoperfusion may result in:
Paralysis/sensory loss bilateral UE
Disturbed vision
Disturbed memory
Chorea
Aphasia
Cortical Areas Supplied by the MCA, ACA and PCA
MCA Infarct

MCA
PCA Infarct

PCA
ACA Infarct ACA
A = Basilar artery
B = Posterior cerebral artery
C = Thalamoperforators
D = Posterior communicating artery
E = Internal carotid artery
F = Middle cerebral artery
G = Anterior cerebral artery
H = Anterior communicating artery
 symmetry
 relatively easy to compare side-to-side
 asymmetry is usually pathological
▪ not all pathology gives rise to asymmetry
 ventricles
 ventricular enlargement may occur with
aging
 hydrocephalus is enlargement
secondary to increased pressure
▪ often caused by obstruction
downstream
 parenchymal changes
 change in density
▪ hyperdense (bright): calcification or
blood
▪ hypodense (dark): ischaemia
 masses
 detail
 grey-white differentiation
 the cortex and white-matter should be
different shades
▪ cortex appears brighter than white matter
▪ if this is blurred, it is suggestive of
ischaemia
 extra-axial spaces
 the brain should extend all the way to
the bone
 the spaces between the brain and skull
is the extra-axial space
▪ hyperdensity may represent acute blood
▪ hypodensity may represent chronic blood
or fluid
 bony defect
 abnormal bone texture
 fractures
 use bone algorithm to see fine