‫ﻛﯿﻔﯿﺔ ﻗﺮاءة ﻣﻔﺮاس اﻟﺪﻣﺎغ‬

‫ﺑﺸﻜﻞ ﻣﺒﺴﻂ‬
‫إﻋﺪاد‪ :‬د‪ .‬ﻟﯿﺚ ﻓﺎﺿﻞ اﻟﺠﺒﻮري‬
‫ﺗﺠﻤﯿﻊ‪ :‬ﻣﺤﻤﺪ ﻣﻮﺳﻰ‬

‫‪1​st​ ed.‬‬
 ‫اﻟﺠﺰء اﻷول‬
‫( ﻻﺑﺪ أن‬Anatomical landmark) ‫ﻟﺴﻬﻮﻟﺔ ﻗﺮاءة ﻣﻔﺮاس اﻟﺪﻣﺎغ ﻧﻘﺴﻢ اﻟﻔﻠﻢ اﻟﻰ ﺛﻼث ﻣﻘﺎﻃﻊ وﻓﻲ ﻛﻞ ﻣﻘﻄﻊ ﻫﻨﺎك‬
‫ﻧﻌﺮﻓﻬﺎ‬

‫اﻟﻤﻘﻄﻊ اﻷول‬
‫ وﻋﻠﻰ ﺟﺎﻧﺒﯿﻪ‬pons ‫ ﻓﻮﻗﻪ‬fourth ventricle ‫ ( اﻟﻤﻬﻢ ﺑﻬﺬا اﻟﻤﻘﻄﻊ ﻫﻮ‬landmark) :‫ﻋﺒﺎره ﻋﻦ أول ﻣﻘﻄﻌﯿﻦ ﺑﺎﻟﻔﻠﻢ‬
Vermis ‫ ﯾﺮﺗﺒﻂ ﻓﺼﻲ اﻟﻤﺨﯿﺦ ﻓﯿﻤﺎ ﺑﯿﻨﻬﻤﺎ ﺑﺎل‬Left and Right cerebellar hemisphere
Basillar artery ‫ أﻛﻮ داﺋﺮه ﺻﻐﯿﺮه ﺑﯿﻀﺎء ﻫﻲ‬pons ‫ﻓﻮق‬

:‫ﻛﻤﺎ ﻣﻮﺿﺢ ﺑﺎﻟﺼﻮر‬

Red point Basillar artery

Green point Pons
Yellow point Fourth ventricle
Blue point cerebellar hemispheres
Black point cerebellar Vermis

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 ‫اﻟﺠﺰء اﻟﺜﺎﻧﻲ‬
‫ﻫﺬا اﻟﻤﻘﻄﻊ ﯾﺴﻤﻰ ‪Basal ganglia level‬‬
‫ﻫﺬا اﻟﻤﻘﻄﻊ ﯾﺤﺘﻮي اﻟﻜﺜﯿﺮ ﻣﻦ ‪Landmarks‬‬
‫ﻛﻤﺎ ﻣﻮﺿﺢ ﺑﺎﻟﺼﻮره‬

‫‪ Basal ganglia .1‬ﺑﺎﻟﻠﻮﻧﯿﻦ اﻟﺴﻤﺎﺋﻲ واﻟﺒﺮﺗﻘﺎﻟﻲ‬

‫‪ Internal capsule .2‬ﺑﺎﻟﻠﻮن اﻻﺻﻔﺮ‬
‫‪ Thalamus .3‬ﺑﺎﻟﻠﻮن اﻷﺣﻤﺮ‬
‫‪ Frontal horn of lateral ventricle .4‬ﺑﺎﻟﻠﻮن اﻻﺧﻀﺮ‬
‫‪ Occipital horn of lateral ventricle .5‬ﺑﺎﻟﻠﻮن اﻻزرق‬

‫ﻣﺜﻞ ﻣﺎ ﻧﻌﺮف ﻣﻦ ان اﻟﺪﻣﺎغ ﻣﻘﺴﻢ إﻟﻰ ‪Frontal; Temporal; parietal and occipital‬‬

‫ﻫﺴﻪ ﻧﺴﺎل ﻓﻲ اي ‪ Level‬ﯾﺒﯿﻦ ﻛﻞ ‪ ??? Lobe‬ﻻزم ﻧﻌﺮف ﺣﺘﻰ ﻣﻦ ﻧﻮﺻﻒ ‪ Lesion‬ﻧﻜﻮل ﻓﻲ ‪frontal or‬‬
‫‪ temporal‬وﻫﻜﺬا ‪...‬‬
‫اﻟﺠﻮاب‬

‫‪-2-‬‬
‫ ﻣﻮﺟﻮدات ﯾﻌﻨﻲ ﯾﻜﻮن‬frontal and occipital horns of lateral ventricle ‫ﻧﺒﺎوع ﻋﻠﻰ اﻟﻔﻠﻢ وﻧﺸﻮف إذا ﻛﺎن‬
Frontal; Temporal and Occipital ‫ اﻟﻲ ﻣﺒﯿﻨﻪ ﺑﺎﻟﻤﻘﻄﻊ ﻫﻲ‬lobes
‫ ﻓﻲ ﺗﻠﻚ اﻟﻤﻘﺎﻃﻊ‬Lobes ‫) راح ﯾﺠﯿﻨﺎ ﺑﺎﻟﻤﻘﻄﻊ اﻟﻘﺎدم( ﻣﺒﯿﻦ راح ﯾﻜﻮن ﺗﻘﺴﯿﻢ‬body of lateral ventricle ‫واذا ﻛﺎن‬
Frontal; parietal and Occipital

‫ﻟﻠﺘﻮﺿﯿﺢ أﻛﺜﺮ‬
‫ اﻟﻲ‬Lobes ‫ ﻣﻮﺟﻮدات راح ﯾﻜﻮن‬frontal and occipital horns of lateral ventricle ‫ اﻟﻲ ﻓﯿﻪ‬Level ‫ﻓﻲ‬
Frontal; Temporal and Occipital ‫ ﻫﻲ‬section ‫ﻣﺒﯿﻨﻪ ﺑﺎل‬

‫ اﻟﻲ‬Lobes ‫) راح ﻧﺤﺠﻲ ﻋﻨﻪ ﺑﺎﻟﺠﺰء اﻟﺜﺎﻟﺚ( ﻣﻮﺟﻮد راح ﯾﻜﻮن‬Body of lateral ventricle ‫ اﻟﻲ ﻓﯿﻪ‬Level ‫ﻓﻲ‬
Frontal; parietal and Occipital ‫ ﻫﻲ‬section ‫ﻣﺒﯿﻨﻪ ﺑﺎل‬

-3-
 ‫اﻟﺠﺰء اﻟﺜﺎﻟﺚ‬
‫ﻫﺬا اﻟﻤﻘﻄﻊ ﯾﺤﺘﻮي ﻋﻠﻰ ‪ Landmark‬واﺣﺪ وﻫﻮ ‪Body of lateral ventricle‬‬
‫ﻓﻲ ﻫﺬا ‪ Level‬ﯾﻜﻮن ‪ Lobes‬اﻟﻲ ﻣﺒﯿﻨﻪ ﻫﻦ‬
‫‪Frontal; parietal and Occipital‬‬

‫اﺧﺮ أرﺑﻊ ﻣﻘﺎﻃﻊ ﻣﻦ اﻟﻤﻔﺮاس ﻧﻘﺴﻤﻬﻦ ﻛﺎﻵﺗﻲ‬

‫اﻟﻤﻘﻄﻌﯿﻦ ﻗﺒﻞ اﻻﺧﯿﺮات ﯾﺒﯿﻦ ﺑﯿﻬﻦ ‪Frontal and parietal‬‬
‫واﺧﺮ ﻣﻘﻄﻌﯿﻦ ﯾﺒﯿﻦ ﺑﺲ ‪parietal‬‬

‫ﻟﻬﻨﺎ ﻛﻤﻞ أﻏﻠﺒﯿﺔ ‪ anatomy‬ﻣﻔﺮاس اﻟﺪﻣﺎغ ) ﺑﻘﺖ ﻛﻢ ﺷﻐﻠﻪ راح اﻧﺰﻟﻪ ﺑﻤﻨﺸﻮر ﺧﺎص ﻷﻫﻤﯿﺘﻬﺎ ﺗﺘﻌﻠﻖ ﺑﺎل ‪( SAH‬‬

‫اﻟﻤﻔﺮاس اﻟﻲ ﻣﻮﺟﻮد ﺑﻬﺬا اﻟﻤﻨﺸﻮر ﯾﺒﯿﻦ ﻣﺴﺘﻮﯾﺎت اﻟﻤﻘﺎﻃﻊ ﻛﺎﻵﺗﻲ ) اﻟﺼﻮره اﻟﺜﺎﻧﯿﻪ (‬

‫‪-4-‬‬
 ‫اﻟﻤﻘﻄﻊ اﻷول ‪ Land mark is Fourth ventricle‬ﺑﺎﻟﻠﻮن اﻟﻮردي‬
‫اﻟﻤﻘﻄﻊ اﻟﺜﺎﻧﻲ ‪ Land marks is Frontal and occipital horns of lateral ventricle‬ﺑﺎﻟﻠﻮن اﻟﺒﺮﺗﻘﺎﻟﻲ‬
‫اﻟﻤﻘﻄﻊ اﻟﺜﺎﻟﺚ ‪ Land marks is Body of lateral ventricle‬ﺑﺎﻟﻠﻮن اﻷزرق‬
‫اﻟﻤﻘﻄﻊ اﻟﺮاﺑﻊ ﯾﺒﯿﻦ ﻓﯿﻪ ‪ Frontal and parietal lobes‬ﺑﺎﻟﻠﻮن اﻻﺻﻔﺮ‬
‫اﻟﻤﻘﻄﻊ اﻟﺨﺎﻣﺲ اﺧﺮ ﻣﻘﻄﻌﯿﻦ ﺑﺎﻟﻤﻔﺮاس ﯾﺒﯿﻦ ﺑﻲ ﺑﺲ ‪ parietal lobe‬ﺑﺎﻟﻠﻮن اﻻﺧﻀﺮ‬

‫‪-5-‬‬
 ‫اﻟﺠﺰء اﻟﺮاﺑﻊ‬
‫‪Normal calicified structures in the brain‬‬
‫ﻫﻨﺎك ﺑﻌﺾ ‪ structures‬ﻧﺸﻮﻓﻬﺎ ‪ calcified‬ﺑﺎﻟﺪﻣﺎغ وﻧﻌﺘﺒﺮ ﻫﺎي ﺗﻜﻠﺴﺎت ﻃﺒﯿﻌﯿﻪ‬

‫أﻫﻤﯿﺔ ﻣﻌﺮﻓﺔ ﻫﺬه اﻟﺘﻜﻠﺴﺎت اﻟﻄﺒﯿﻌﯿﻪ ﻛﻲ ﻻ ﺗﻮﻫﻤﻨﺎ ﺑﺤﯿﺚ ﻧﻌﺘﺒﺮﻫﺎ ‪ hemorrhage‬ﻻن أﺛﻨﯿﻨﻬﻦ ﯾﻨﻄﻦ ‪Hyperdense‬‬

‫ﯾﻤﻜﻦ أن ﻧﻔﺮق ﺑﯿﻦ اﻻﺛﻨﯿﻦ ﻗﺼﺪي ‪ hemorrhage or calcification‬ﺑﺎﺳﺘﻌﻤﺎل ‪CT bone window‬‬

‫أﻫﻢ اﻟﺘﻜﻠﺴﺎت اﻟﻄﺒﯿﻌﯿﻪ ﻫﻲ‬

‫‪Choroid plexus ( after the age of 20 ) .1‬‬
‫‪2. Pineal body‬‬
‫‪3. Basal ganglia‬‬
‫‪4. Falx‬‬

‫واﻟﺼﻮر أدﻧﺎه ﺗﺒﯿﻦ ﻫﺬه اﻟﺘﻜﻠﺴﺎت اﻟﻄﺒﯿﻌﯿﺔ‬

‫‪-6-‬‬
-7-
 ‫اﻟﺠﺰء اﻟﺨﺎﻣﺲ‬
‫)‪Subarachnoid hemorrhage(SAH‬‬

‫ﻣﺜﻞ ﻣﺎﻫﻮ ﻣﻌﺮوف ان اﻟﻨﺰف ﺑﺎﻟﺪﻣﺎغ ﯾﺒﯿﻦ أﺑﯿﺾ ﺑﺎﻟﻤﻔﺮاس )‪(Hyperdense‬‬

‫ﺑﻌﺾ اﻻﺣﯿﺎن ﻧﺸﻮف ‪ Hyperdense‬ﻣﻨﺘﺸﺮه) ﻣﻄﺸﺮه( ﺑﺄﻛﺜﺮ ﻣﻦ ﻣﻜﺎن ﺑﺎﻟﻤﻔﺮاس‪ ،‬ﻓﻲ ﻫﺬه اﻟﺤﺎﻟﻪ ﯾﺠﻲ اﺑﺎﻟﻨﻪ اﻧﻪ ﻫﻜﺬا‬
‫ﻧﺰف ﻣﻄﺸﺮ ﻣﻤﻜﻦ ان ﯾﻜﻮن ‪SAH‬‬

‫ﻧﺠﻲ ﻧﺴﺄل ﺑﺎي ﻣﻜﺎن ﺑﺎﻟﺪﻣﺎغ ﻧﺸﻮف ‪ Hyperdense‬وﻧﻘﻮل أﺣﺘﻤﺎل ﯾﻜﻮن ‪ SAH‬ﺑﻤﻌﻨﻰ أﺧﺮ ﻣﺎﻫﻲ اﻟﻤﻨﺎﻃﻖ اﻟﻲ ﻣﻦ‬
‫اﻟﻤﻤﻜﻦ ان ‪ SAH‬ﯾﺴﺒﺐ ﺑﯿﻬﺎ ‪Hyperdense‬‬

‫‪1. Anterior and posterior hemispheric fissures‬‬

‫ﻛﻤﺎ ﻣﻮﺿﺤﻪ ﺑﺎﻟﺼﻮره ﺑﺎﻟﻠﻮن اﻟﺒﺮﺗﻘﺎﻟﻲ‬
‫)‪2. Guadrigerminal cistern (normally it black‬‬
‫ﻛﻤﺎ ﻣﻮﺿﺤﻪ ﺑﺎﻟﺼﻮره ﺑﺎﻟﻠﻮن اﻟﺒﻨﻔﺴﺠﻲ‬
‫‪3. Syllivan fissure‬‬
‫ﻛﻤﺎ ﻣﻮﺿﺢ ﺑﺎﻟﺼﻮره ﺑﺎﻟﻠﻮن اﻷزرق‬

‫‪-8-‬‬
 ‫اﻟﺠﺰء اﻟﺴﺎدس‬
Different substance have different relative densities thus ; different Hounsfield

‫ﺑﻤﻌﻨﻰ أﺧﺮ‬

If you are not sure what you are looking at ; measure it Hounsfield unite!!!!!

-9-
 ‫اﻟﺠﺰء اﻟﺴﺎﺑﻊ‬
‫‪CVA‬‬
‫ﻣﺜﻞ ﻣﺎ ﻗﻠﻨﺎ ان ‪ CVA‬اﻣﺎﻧﺰف )اﻟﻲ ﯾﻬﻤﻨﺎ ‪ SAH‬وﺣﺠﯿﻨﻪ ﻋﻠﯿﻪ ﺳﺎﺑﻘﺎ او )‪ Intracerebral‬اﻟﻲ راح ﻧﺤﺠﻲ ﻋﻨﻪ ﻫﻨﺎ( او‬
‫ﺧﺜﺮه‬

‫اﻟﺠﻠﻄﻪ اﻟﺨﺜﺮﯾﻪ )‪ (Ischemic‬ﻣﺎﺗﺒﯿﻦ ﺑﺎﻟﺒﺪاﯾﻪ ﯾﻌﻨﻲ اذا إﺟﻪ ﻣﺮﯾﺾ ﻋﻨﺪه أﻋﺮاض ﺳﺘﺮوك واﻟﻤﻔﺮاس ﻣﺎﺑﻲ ﺷﻲ ﻣﺎﻧﻜﻮل‬
‫ﻧﻮرﻣﻞ ﻧﻜﻮل )‪(No hemorrhage‬‬

‫اﻟﺠﻠﻄﻪ اﻟﺨﺜﺮﯾﻪ اﻣﺎ ‪ Acute‬ﺗﺒﯿﻦ ‪ Hypodense‬أﻏﻤﻖ ﻣﻦ ﻟﻮن اﻟﺪﻣﺎغ واﻓﺘﺢ ﻣﻦ ﻟﻮن ‪ CSF‬ووﺻﻔﻬﺎ ﺣﺴﺐ ‪lobes‬‬
‫ﻛﻤﺎ ﻓﻲ ﺻﻮر ‪ 1‬و ‪ 2‬و‪3‬‬

‫‪-10-‬‬
‫اﻣﺎ ‪ CVA‬اﻟﻘﺪﯾﻤﻪ ﺗﻜﻮن ‪ Hypodense‬وﻟﻮﻧﻬﺎ ﻣﺜﻞ ﻟﻮن ‪CSF‬‬
‫ﻛﻤﺎ ﻓﻲ اﻟﺼﻮرة ‪4‬‬

‫‪-11-‬‬
 ‫اﻣﺎ ‪ intracerebral hemorrhage‬ﯾﺒﯿﻦ أﺑﯿﺾ ‪ Hyperdense‬وﺣﺴﺐ ﻣﻮﻗﻌﻪ ﺑﺎي ‪ lobes‬واﺛﻨﺎء اﻟﻮﺻﻒ‬
‫اﻟﺤﺠﻢ واﻟﻤﻜﺎن ﻧﺸﻮف اﻛﻮ ‪ Ventricular Extension‬اﻛﻮ ‪ shift midline‬اﻛﻮ ‪ mass effect‬اﻛﻮ ﺣﻮل اﻟﻨﺰف‬
‫‪ cerebral Oedema‬اﻟﻲ ﺗﺒﯿﻦ ﻋﻠﻰ ﺷﻜﻞ ‪ Rim‬اﺳﻮد ﺣﻮل اﻟﻨﺰف ﻛﻤﺎ ﻓﻲ ﺻﻮره ‪5‬‬

‫‪-12-‬‬