You are on page 1of 82

NEUROPSYCHIATRY

Dr. Muh. Ilyas, Sp.Rad

DEPARTEMENT OF RADIOLOGY
MEDICAL FACULTY
HASASUDDIN UNIVERSITY


Introduction
Radiologic modality for detected the abnormality
in Neuropsiciatry are :
 Plain foto of the skull
 CT – scan
 MRI
 Ultrasonography (Intracranial Doppler)
 Angiography
 Myelography


Introduction
Indication for radiology examination in
Neuropsychiatry diseases :
 Chronic Cephalgia
 Vertigo
 Occult edema pupil or combination
 Dysartr
 Visus Defect and memory problem
 Epilepsy
SKULL PLAIN FOTO
 Some intracranial defect cannot detected with
this examination
 Routine position  AP & Lateral
 Skulll foto can give information about :
- The shape & the size of the calvaria
- Calcification, erosion or local sclerotic.
- Shape & size of sella turcica
- Suture
- Vascularisation

Skull foto, lateral position :
Normal
Skull Foto AP/lat : Normal Calsification
The Abnormality
Increase of intracranial pressure make the
calvaria change 
- dyastasis (find in children )
- Erosion of dorsum sella
- Local erosion or local hyperostosis
- Impressio digitatae (thumb printing)

Primer tumor
The characteristic of primer tumor in skull photo
are
 Abnormal Calcification
 Local erosion/sclerotic
 Erosion of Sella turcica
 Dilatation of the vein that effected by abnormal
vascularisation of the tumor.
 Displacement of glandula pinealis.
 Sign of increase intracranial pressure
Lateral skull Foto : Increase of
intracranial pressure
Skull foto (AP) : Astrocytoma
Metastatic Tumor
 Multiple coin lesion appeareance
 Sign of Increase intracranial pressure
Hydrocephalus
Radiology finding in skull photo are :
 Change of shape & size of the skull
 Suture Dyastasis
 Erosion of the calvaria
Skull foto AP/Lat : Hydrocephalus
Brain CT Scan
The Lesion density divided by :
 High density (hyperdens)  if the density
of the lesion is more than the normal brain
 Isodensity  if the density of the lesion is
same with the normal brain.
 Low density (hypodens)  if the density
of the lesion is lower than the normal
brain.
Abnormality that can find in
Head CT Scan :
 Brain Tumor
 Abnormality in cerebrovasculer
 Anomali
 Infection diseases
 Cerebral atrophy/degenerative
diseases
CT Scan Finding of the Brain tumor :

 Mass Effect (sign of emphasis,
displacement and obstruction )
 Perifocal Edema
 Calcification

a.
b.
Meningitis Tuberkulosa : a. CT, b. MRI
ENCHEPHALITIS
Cerebrovasculer Abnormality
cerebrovasculer Abnormality is consisted of :
 Intracerebral Hemorragic  hypertension
 Infark
 Aneurysm
 Arteriovenous malformation
Miliary Tuberculosis
Tuberculoma
Alzheimer’s Disease
Encephalitis : a. CT non contast, b. CT contrast
a.
b.
Intracerebral Hemorragic By
Hipertension
 Caused by ruptured of microaneurysma
arteriole.
 In acute fase  the blood density is hyperdens
or isodens, oval/irrreguler.
 The lesion is surrounded by perifocal edema,
sometimes with mass effect (compression or
herniation).
 In Chronic fase  the density of the hematoma
is isodens or hypodens , the ventricle syst. and
the sulci dilated caused of atrophy
 CT + contras  homogen enhancement or ring
enhancement.


Left Intracerebri Hemorragic & Bilateral
Intraventricular Hemorragic
CLINIC: LEFT LATERALISATION EC HS
CLINIC : TRAUMA CAPITIS (GCS = 9)
SUBDURAL HEMATOMA with SUB FALK HERNIATION
KLINIS : KESADARAN MENURUN
PERDARAHAN SUBARACNOID,
INTRAVENTRIKULAR BILATERAL DAN PON
Infark cerebri
 Happen by occlusion of cerebral vein that
make necrotic of the brain.
 Necrotic/ischemic of the brain caused by :
- Thrombosis
- Emboli
 In acute stage  usually there is no
abnormality in ct scan.
 After 4 days  There is hypodens area,
rounded/oval/irreguler.

Infark Cerebri
KLINIS : KESADARAN MENURUN
INFARK CEREBRI KANAN
Infark Haemorrhagic : a. CT, b. MRI T1Wi
a.
b.
Aneurysm
 Angiography is the best modality for
diagnose because aneurysm is a vascular
abnormality.
 CT Scan  good for detected the
complication of aneurysm ,like :
Intracerebral hematoma, infark & edema
Coronal
Axial
Arteriovenous Malformation
 AVM  blood flow from artery to venous
without passing the capillary.
 In CT without contras  there is
calcification, sometimes hyperdens
lesion and hydrocephalus.
 CT scan + contrast  there is tubular
enhancement/tortuous.
Central Nerve System Anomaly
CNS Anomaly :
 Congenital Hydrocephalus
 Agenesis Corpus Callosum
 Sturge-weber synd.
 Sclerosis tuberous (Bourneville
diseases)
Congenital Hydrocephalus
 Caused of aquaduct stenosis or stenosis os
fomanen magendi & Luscka and anomaly of
fossa posterior structure.
 CT scan  dilated of ventricle lateralis & 3
rd

ventricle in aquaduct stenosis but the 4
th

ventricle still normal.
 Dandy Walker synd  dilated of ventricle
lateralis , 3
rd
ventricle & 4
th
ventricle.
Hydrocephalus
Hydrocephalus
KLINIS ; HIDROCHEPHALUS
HYDRANENCHEPALY
Agenesis Corpus Callosum
 Caused of corpus callosum not growth ,
maybe caused by a trauma in first
semester of the pregnancy.
 CT scan finding  agenesis of corpus
callosum, agenesis septum pellucidum,
with position of 3
rd
ventricle is higher ,
the right & left lateral ventricle are
separate.
Cerebral Abcess
 Caused by sprending infection of otitis
media/ mastoiditis.
 soliter or multiple
 CT scan finding  hypodens area in the
cortex or corticomedullar junction
 CT + contras  ring enhancement
surrounding the hypodens area. There is
perifocal edema out of the ring
enhancment .

a.
b.
Abces Cerebri : a. CT non contrast, b. CT contrast
Cerebral atrophy
 CT scan finding  The space between
tabula interna & the outer margin of the
cortex cerebri more wider.
Sulci, Silvii fissure & cistern basalis are
wider too.
Atrofi Cerebri
M R I
 One of Radiology modality 
produced picture of human body scan
without X ray but used magnetic.

1. Isointens
2. Hypointens
3. Hiperintens
There is 3 intensity in MRI :
Example :
 Water : hypointens in T1 & become
hyperintens in T2
 Fat or blood : hyperintens in T1 & T2
 Calsification : hypointens in T1 & T2
T1 : longitudinal relaxation time (TR short dan TE
short)
T2 : transversal relaxation time (TR long dan TE
long)
Pesawat MRI
The Advantage of MRI
1. No X ray
2. No damage to body if the use is right
3. Many examination can do without contrast, not
invasif and not used iodium contrast
4. MR can show biologic parameter
(spectroscopy), for example ; can show the
different of solid mass, fat/non fat, fluid, & the
age of the hemorragic.
5. Can produce 3 D scan/direct multi planar
without change the patient position .
6. Very sensitive for soft tissue morphology
The Loss of MRI
1. Expensive
2. Take more time for examination
3. Cannot use to Patient with metal
(pacemaker, ferromagnetic)
4. Klaustrophoby
5. Need more cooperation from the patient,
sometimes need general anesthetic for
unstable patient & children.


MRI : Lacunar Infark
Indication for Brain MRI
1. Tumor
2. Hemorrhagic Infark /non hemorrhagic
perdarahan.
3. Demyelinisation diseases ( multiple
sclerotic)
4. Vascular abnormality.
5. Infection
6. Metastasis.
Brain MRI : normal
MRI : Subdural Hemorrhage, pre & post kontras
MRI : Hydrocephalus
MRI : Partial Agenesis of Corpus Callosum
Myelography
 Myelography  radiology modality which
can show the structure of canalis spinalis
with inject contras in to the canalis
spinalis.
 Contras can divede in to 2 group :
- Contras negatif : air
- Contras positif : - water soluble
- oil soluble
The abnormality in myelography:
 Hernia nucleus pulpous (HNP)
 Tumor, :
- Extradural tumor
- Intradural tumor , divided into :
- intramedular
- extramedular
 Congenital abnormality (malformasi) :
- meningochele
- meningomyelochele
 Arachnoiditis

Hernia Nucleus Pulposus
 HNP : protrusion of the disc to posterior
which can compress the nerve, medulla
spinalis  neurological sign.
 HNP  can find in younger or older patient
 In younger patient usually caused by
trauma or gravitation of column vertebra
which receive more weight barring
 In older patient usually caused by
degenerative disc process, starting with
disc inertia and then loss of elasticity of
nucleus and degenerative of chondral
joint
MRI : Nucleus Pulposus

 Grading of Hernia :

- Protruded intervertebral disc
Protrution of Nucleus menonjol to one direction without
annulus fibrous damage
- Prolaps intervertebral disc
Displacement of Nucleus but still in annulus ring.
- Extruded intervertebral disc
Nucleus out from the annulus and residing below
the lig. longitudinal post.
- Sequestrated intervertebral disc
Nucleus penetrate the lig.longitudinal post.



MACROADENOMA HIPOFISE
KLINIS : CEFALGIA EC. TUMOR OTAK
ASTROCYTOMA
KLINIS : HEMIPARESE SNISTRA EC. NHS
KLINIS : CARSINOMA THYROID
CARSINOMA THYROID KANAN
KLINIS : TONSILOPHARINGITIS AKUT
POLIP SINUS MAXILLARIS KIRI
SINUSITIS SPHENODALIS DA N FRONTALIS
KLINIS : CEPHALGIA + SINUSITIS
PANSINUSITIS
KLINIS : OMSK
CHOLESTIATOM SINISTRA
SINUSITIS MAXILLARIS KANAN
KLINIS : SUSPEK POLIP NASI