LIFE THREATENING

BRAIN PATHOLOGIES
B Y: N I T H I N S H E N O I
 PATHOLOGIES

1. Subarachnoid hemorrhage
2. Subdural hematoma
3. Epidural hematoma
4. Intraparenchymal hemorrhage
5. Tonsillar herniation (Chiari I Malformation)
 SUBARACHNOID HEMORRHAGE
What is it?
• Injury of small arteries or
veins on the surface of the brain
• Space between the Pia and
Arachnoid matter
• The most common cause is
trauma
• In the absence of significant
trauma the most common cause
is the rupture of a cerebral
aneurysm
How does it present?
• Focal high density in sulci
and fissures
• Linear hyperdensity in the
cerebral sulci
• Blood in the subarachnoid
space can fill or partly fill
the sulci, fissures, basal
cisterns and ventricles
SUBARACHNOID HEMORRHAGE CT
Subarachnoid blood in the  Blood along the right cerebral
prepontine cisterns convexity
SUBARACHNOID HEMORRHAGE CT
Intraventricular blood in the left lateral ventricle, the aqueduct and
the 4th ventricle
SUBARACHNOID HEMORRHAGE CT
Blood in all basal cisterns, bilateral Sylvian fissure and
interhemispheric fissure
SUBARACHNOID HEMORRHAGE CT
Blood in Sylvian fissures and Blood in Sylvian fissures and
Basal cisterns over Tentorium
SUBARACHNOID HEMORRHAGE CT
Calcification of the choroid plexus is a normal finding which should
not be mistaken for intraventricular blood
SUBARACHNOID HEMORRHAGE MRI

T2-FLAIR Diffusion-weighted
SUBARACHNOID HEMORRHAGE MRI

T2 T1
 SUBDURAL HEMATOMA

What is it? How does it present?

• Deceleration and • Crescent shaped
acceleration or rotational • Hyperdense
forces that tear bridging • may contain hypodense foci
veins  due to serum, CSF or active
• Space between the bleeding
arachnoid matter and the • Does not cross dural
dura matter reflections
 SUBDURAL HEMATOMA CT
Hypodense region may indicate
Shift of the normally midline septum active bleeding
pellucidum due to the mass effect
SUBDURAL HEMATOMA CT

Acute Chronic with rebleeding

SUBDURAL HEMATOMA CT
The dense (white) material represents recently
clotted blood while the less dense blood (grey) has
Hyperacute not had time to clot
 SUBDURAL HEMATOMA CT
Chronic shows septations and
loculations that often occur over
time
Subacute compression of
gray and white matter in the left hemisphere
due to the mass effect
 SUBDURAL HEMATOMA MRI
Hyperintense on the T2- Hyperintense on the sagittal T1-
weighted  weighted
 EPIDURAL HEMATOMA

What is it? How does it present?

• Usually associated with a • Hyperdense biconvex mass
skull fracture • Extradural and Lenticular
• Impact fractures the • Can cross the dural
calvarium reflections
• The fractured bone lacerates
a dural artery or a venous
sinus
• Collects between the skull
and dura
 EPIDURAL HEMATOMA CT

Deep to the parietal skull Post-traumatic intracranial hemorrhage at

the site of impact can be referred to as a
'coup' injury
 EPIDURAL HEMATOMA CT

 Left parietal lobe, causing significant midline shift and entrapment

hydrocephalus
 EPIDURAL HEMATOMA CT
Left temporal epidural hematoma with a comminuted fracture of the
temporal bone & multiple facial fractures
 EPIDURAL HEMATOMA MRI

Left occipital subacute T1 and T2-weighted

INTRAPARENCHYMAL HEMORRHAGE

What is it? How does it present?

• IPH is one form of • Basal ganglia
intracerebral bleeding in • Thalamus
which there is bleeding • Pontine
within brain parenchyma
• Cerebellar
• The other form is
• Lobar
intraventricular hemorrhage 
(IVH)
• Hemorrhagic Stroke
INTRAPARENCHYMAL HEMORRHAGE CT

Round, hyperdense focus at right

Basal ganglia of the left thalamic nucleus
hemisphere and into the ventricle
INTRAPARENCHYMAL HEMORRHAGE CT

Pontine hemorrhage with

Thalamic nucleus extension of blood into the fourth
ventricle and up into the third
ventricle
INTRAPARENCHYMAL HEMORRHAGE CT

Pontine hemorrhage
INTRAPARENCHYMAL HEMORRHAGE CT
Partially effacing the fourth
 Cerebellar hemorrhage with ventricle, resulting in mild
intraventricular extension and hydrocephalus
hydrocephalus
INTRAPARENCHYMAL HEMORRHAGE CT

Hemorrhagic focus in the right frontal lobe, flanked

Posterior aspect of the right by edema of the adjacent parenchyma. Extension of
cerebral hemisphere - Warfarin bleeding for the subdural space along the right
cerebral hemisphere, cerebellum tent and space
interhemispheric
 INTRAPARENCHYMAL HEMORRHAGE
MRI

Hemorrhages of various ages are  Late subacute intracranial

seen in the left cerebellar hemorrhage.
hemisphere with blood-fluid
levels
 TONSILLAR HERNIATIONS
What is it?
• Inferior descent of the
cerebellar tonsils below the
foramen magnum
• Clinically the presence of
tonsillar herniation is often
called coning
How does it present?
• Effacement of the CSF
cisterns surrounding the
brainstem and as inferior
descent of the cerebellar
tonsils below the level of
the foramen magnum
TONSILLAR HERNIATIONS

Chiari I Malformation
 TONSILLAR HERNIATIONS
Flattening of the medulla
anteroposteriorly
TONSILLAR HERNIATIONS

 Notching of the posterior arch of C1 and a

prominent internal occipital protuberance
that extends deeply between the cerebellar
hemisphere