The Brain

Lecture by: M.K. Sastry

Program Director,
Post Graduate Studies and PhD Program
Brain Anatomy
ANATOMY
ANATOMY
 STROKE
 A stroke, sometimes referred to by the older
term cerebrovascular accident (CVA), is the
rapid loss of brain function due to disturbance
in the blood supply to the brain. This can be due
to ischemia (lack of blood flow) caused by
blockage (thrombosis), or a hemorrhage .
 STROKE
 As a result, the affected area of the brain cannot
function, which might result in:
1. Inability to move one or more limbs on one side
of the body.

2. Inability to understand or formulate speech.

3. Inability to see one side of the visual field.

 Risk Factors
 A stroke is a medical emergency and can cause
permanent neurological damage and death.

  Risk factors for stroke include old age, high blood

pressure, previous stroke, diabetes, high
cholesterol, tobacco smoking and atrial
fibrillation.
 Risk Factors
 High blood pressure is the most important
variable risk factor of stroke. It is the second
leading cause of death worldwide .
 Stroke Symptoms
1. Sudden numbness or weakness of the face, arm, or
leg (especially on one side of the body).

2. Sudden confusion, trouble speaking, or difficulty

understanding speech.

3. Sudden trouble seeing in one or both eyes.

 Stroke Symptoms

4. Sudden trouble walking, dizziness, or loss of balance

or coordination.

5. Sudden severe headache with no known cause.

 Diagnosis
 Stroke is diagnosed through several techniques:

1. Physical examination (neurological examination)

A. A physical examination, including taking a medical
history of the symptoms and a neurological status,
helps giving an evaluation of the location and
severity of a stroke. It can give a standard score on
e.g., the NIH stroke scale ??????.
 Diagnosis
 Stroke is diagnosed through several techniques:

2. Imaging
For diagnosing ischemic stroke in the emergency setting:

A. A. CT scans (without contrast enhancements)

sensitivity= 89% specificity= 100% MRI scan
sensitivity= 81% specificity= 100%

B. MRI
 Treatment for Stroke
 The most promising treatment of ischemic stroke is
the FDA-approved, clot-busing drug t-PA (tissue
plasminogen activator).
 It must be administered within a four and half
hours from the onset of symptoms.
 The sooner it is administered, the more effective it
is.
 Treatment for Stroke
 It has been used to treat well over 100,000
ischemic stroke patients.
 Administering t-PA or other clot-dissolving agents is
done through an intravenous (IV) line in the arm by
hospital personnel over 60 minutes.  If given
quickly, t-PA can significantly reduce the effects of
stroke and reduce permanent disability.
 CT scan slice of the brain showing a right-
hemispheric ischemic stroke (left side of image)
 CT scan slice of the brain showing a left-
hemispheric ischemic stroke (R side of image)
 Cerebral infarction (stroke)
In MRI
 PD T2
 Stroke In MRI
 These transverse proton-density (left) and T2-
weighted (right) images demonstrate an acute left
temporal lobe infarct.
 intravenous contrast is usually administered in the
evaluation of infarction since it can both aid in the
detection of an early infarct and can help determine
the age of the infarct.
 Stroke In MRI
 Although hyperacute hemorrhage (less than 24 hours
ago) can be difficult to detect in MRI
 MRI is very sensitive for the detection of even small
amounts of hemorrhage after the first day.
 Cerebral Hemorrhage
 A cerebral hemorrhage. It is alternatively called
intra-cerebral hemorrhage (ICH). It can be caused by
brain trauma, or it can occur spontaneously in
hemorrhagic stroke.
 Non-traumatic intracerebral hemorrhage is a
spontaneous bleeding into the brain tissue.
 Cerebral Hemorrhage
 A cerebral hemorrhage could be:
A. Intra-axial hemorrhage
B. Extra-axial hemorrhage
1. Intra-axial hemorrhage that is, it occurs within the
brain tissue rather than outside of it.
 There are two main kinds of intra-axial
hemorrhages: intraparenchymal hemorrhage and
intraventricular hemorrhages.
 Cerebral Hemorrhage
1. Intra-axial hemorrhage that is, it occurs within the
brain tissue rather than outside of it.
 Intraparenchymal bleeds are a serious medical
emergency because they can increase intracranial
pressure which if left untreated can lead to coma
and death.
 The mortality rate for intraparenchymal bleeds is
over 40%.[
 Cerebral Hemorrhage
2. The other category of intracranial hemorrhage is
extra-axial hemorrhage .
 It can be classified to:

A. Epidural hematomas

B. Subdural hematomas
C. subarachnoid hematomas, which all occur
within the skull but outside of the brain tissue.
 Causes of ICH
1. Intra-cerebral bleeds are the second most common
cause of stroke.

2. High blood pressure raises the risks of spontaneous

intra-cerebral hemorrhage by two to six times.

3. Intra-parenchymal bleeds are usually due to

penetrating head trauma, but can also be due to
depressed skull fractures.
 Causes of ICH
4. Rupture of an aneurysm .

5. Arteriovenous malformation(AVM).

6. Bleeding within a tumor are additional causes.

 Diagnosis
 Intra-parenchymal hemorrhage can be recognized
on CT scans because blood appears brighter than
other tissue and is separated from the inner table
of the skull by brain tissue.
 Diagnosis
 The tissue surrounding a bleed is often less dense
than the rest of the brain because of edema, and
therefore shows up darker on the CT scan.

 CT angiogram will be performed in order to

exclude a secondary cause of hemorrhage.
intra-ventricular hemorrhage
Intra-parenchymal hematoma
Epidural hemorrhage
Subdural hemorrhage
Subarachnoid hemorrhage
 Brain Tumors
 A brain tumor, or tumor, is an intracranial
solid neoplasm and also defined as an abnormal
growth of cells within the brain or the central spinal
canal.
 Brain tumors include all tumors inside the cranium or
in the central spinal canal.
 Brain Tumors
 They are created by an abnormal and
uncontrolled cell division, usually in the brain itself,
but also in lymphatic tissue, in blood vessels, in
the cranial nerves, in the brain envelopes
(meninges), skull, pituitary gland, or pineal gland.
 Signs and symptoms
 Visibility of signs and symptoms of brain tumors
mainly depends on two factors
1. Tumor size (volume)
2. Tumor location
 Types of brain tumors.
 Tumors can be benign or malignant.
 Signs and symptoms
 Can occur in different parts of the brain, and may or
may not be primary tumors, as opposed to
ametastatic tumor, which is something that has
spread to the brain from another part of the body.
  The incidence of metastatic tumors are more
prevalent than primary tumors.
 Signs and symptoms
 The most common primary brain tumors are:

 Gliomas (50.4%)

 Meningiomas (20.8%)
 Pituitary adenomas (15%)
 Diagnosis by CT & MRI
 Imaging plays a central role in the diagnosis of brain
tumors., especially magnetic resonance imaging
(MRI) and computed tomography (CT)-scans.
 Neoplasms will often show as differently colored
masses) in CT or MRI results.
 Diagnosis by CT & MRI
 Contrast agent uptake can be demonstrated on
either CT or MRI-scans in most malignant primary
and metastatic brain tumors.
A glioma is a type of malignant  tumor that starts in the brain
or spine. Gliomas make up 80% of all malignant brain tumors.
WITH OUT CONTRAST WITH CONTRAST
 Benign brain tumors often show up as hypodense
(darker than brain tissue) mass lesions on cranial CT-
scans (Meningiomas)
 CT of brain with benign right temporal arachnoid cyst
Pituitary adenomas( Benign )
CT WITH CONTRAST
On MRI, they appear either hypo- (darker than brain tissue)
or isointense (same intensity as brain tissue) on T1-
weighted scans
Hyperintense (brighter than brain tissue) on T2-weighted MRI
 T1 WITH CONTRAST
Perifocal edema, or
pressure-areas, or
where the brain tissue
has been compressed
also appears
hypointense on T1-
weighted MRI, they
might indicate the
presence a diffuse
neoplasm (unclear
outline)
Thank You