dr a gazdar 04/09/2013 interpretation of ct brain- neuro surgical prospective

DR A GAZDAR04/09 /2013

Interpretation of CT Brain- neuro

surgical prospective

CT

Sliced angled images of brain from skull base to vertex.

Either cross sectional (axial) / coronal / sagittal images

Radiocontrast used is iodinated : !!!allergy

Normal anatomyA. Frontal LobeB. Frontal Bone

(Superior Surface of Orbital Part)

C. Dorsum SellaeD. Basilar ArteryE. Temporal LobeF. Mastoid Air CellsG. Cerebellar

Hemisphere

A. Frontal LobeB. Sylvian FissureC. Temporal LobeD. Suprasellar

CisternE. MidbrainF. Fourth VentricleG. Cerebellar

Hemisphere

A. Falx CerebriB. Frontal LobeC. Anterior Horn of

Lateral VentricleD. Third VentricleE. Quadrigeminal

Plate CisternF. Cerebellum

A. Anterior Horn of the Lateral Ventricle

B. Caudate NucleusC. Anterior Limb of the

Internal CapsuleD. Putamen and Globus

PallidusE. Posterior Limb of the

Internal CapsuleF. Third VentricleG. Quadrigeminal Plate

CisternH. Cerebellar VermisI. Occipital Lobe

A. Genu of the Corpus Callosum

B. Anterior Horn of the Lateral Ventricle

C. Internal CapsuleD. ThalamusE. Pineal GlandF. Choroid PlexusG. Straight Sinus

A. Falx CerebriB. Frontal LobeC. Body of the Lateral

VentricleD. Splenium of the

Corpus CallosumE. Parietal LobeF. Occipital LobeG. Superior Sagittal

Sinus

A. Falx CerebriB. SulcusC. GyrusD. Superior Sagittal

Sinus

Trauma

Both brain and bone windows need to be examined

Fractures are noted in sinuses, skull base, mastoid bone, temporal (petrous), skull.

Either linear or depressed.Either displaced or

undisplaced

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=GcundRg0O_iccM&tbnid=Rt9DC1X4ixDaPM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.surgical-tutor.org.uk%2Fcore%2Ftrauma%2Fhead_trauma.htm&ei=ZkMmUpySO4fjkgWNqoGoCA&bvm=bv.51495398,d.dGI&psig=AFQjCNGGANiIBAlwQLoUaa42gdvJ1HqfPw&ust=1378325726778260

SAH

Most commonly associated with vascular anomalies

Aneurysm, AVMCT grading is

Fischer grade

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=tm40sk-YHZTR0M&tbnid=Wk2pBVzl6VlH9M:&ved=0CAUQjRw&url=http%3A%2F%2Flifeinthefastlane.com%2F2009%2F09%2Fsubarachnoid-haemorrhage%2F&ei=5DMmUrLcDYeLkgWVkIFo&bvm=bv.51495398,d.dGI&psig=AFQjCNFOSGa73XuNkx9ndP9JBtcZTh1G8Q&ust=1378321747652256

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=zgAUENnVSU1LiM&tbnid=cDmRcvk5lN-NrM:&ved=0CAUQjRw&url=http%3A%2F%2Fen.wikipedia.org%2Fwiki%2FSubarachnoid_hemorrhage&ei=FjQmUuW8Fc3YkQWmxICwBw&bvm=bv.51495398,d.dGI&psig=AFQjCNFOSGa73XuNkx9ndP9JBtcZTh1G8Q&ust=1378321747652256

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=iFU7NcWUEBRn4M&tbnid=LgXihFxfFg2H0M:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.uhs.nhs.uk%2FOurServices%2FBrainspineandneuromuscular%2FNeurovascularservice%2FNeurovascularconditions%2FSubArachnoidHaemorrhage%2FInvestigations.aspx&ei=WzQmUufrLsKokAXPnYHABw&bvm=bv.51495398,d.dGI&psig=AFQjCNFOSGa73XuNkx9ndP9JBtcZTh1G8Q&ust=1378321747652256

Acute SDH

NSx emergencyCrescent shapedHyperdense, may

contain hypodense foci due to serum, CSF or active bleeding

Does not cross dural reflections

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=oa3h3BBputfrzM&tbnid=i8kE6OXRYFULpM:&ved=0CAUQjRw&url=http%3A%2F%2Fmeddic.jp%2Facute_subdural_hematoma&ei=5jUmUt_DAsnOkAWO_IDYCA&bvm=bv.51495398,d.dGI&psig=AFQjCNGIHv5Q2XD3bl1bsg4vU41otfxtHw&ust=1378322265175185

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=oa3h3BBputfrzM&tbnid=i8kE6OXRYFULpM:&ved=0CAUQjRw&url=http%3A%2F%2Fmeddic.jp%2Facute_subdural_hematoma&ei=5jUmUt_DAsnOkAWO_IDYCA&bvm=bv.51495398,d.dGI&psig=AFQjCNGIHv5Q2XD3bl1bsg4vU41otfxtHw&ust=1378322265175185

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=tQAg80bEWNeK4M&tbnid=O3g17OmXpQZDBM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.hindawi.com%2Fjournals%2Fijvm%2F2012%2F753596%2Ffig2%2F&ei=eTYmUr7nGo7MkQWR5IHQDQ&psig=AFQjCNGIHv5Q2XD3bl1bsg4vU41otfxtHw&ust=1378322265175185

EDH

Associated with skull fractures

Hyerdense biconvexCan cross the dural

borders

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=G_2PGPjLqAnFJM&tbnid=JHCvfUgZaEaqUM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.catscanman.net%2Fblog%2F2009%2F05%2Fscanmans-casebook-case-18%2F&ei=HTcmUonTI8b_kAXq0IHADA&psig=AFQjCNE4Rp5huuR-3MWiEHb6e4B99652sw&ust=1378322583090801




http://www.catscanman.net/blog/wp-content/uploads/casebook/edh1a.jpg

contusions

ill-defined hypodense area mixed with foci of hemorrhage.

Adjacent subarachnoid hemorrhage is common.

>24-48 hours, hemorrhagic transformation or coalescence of petechial hemorrhages : evolution

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=5By1QuMKmHkrLM&tbnid=TPpoHivvJMUqzM:&ved=0CAUQjRw&url=http%3A%2F%2Fradiopaedia.org%2Fimages%2F156914&ei=cTgmUsPYNYaVkQW64YDIDQ&psig=AFQjCNHjcMyg-10JfdjXMMrZx4-2SxZ0xQ&ust=1378322824365580



tumors

Contrast needed to delineate

Multiple at grey white junction– mets

Dural based – meningioma

Diffuse intraparenchymal – high grade gliomas

hydrocephalous

Communicating or obstructive

Trapped hornsLook for causeAssociated hardware

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=lm9OA9IQpFqvJM&tbnid=HfkQ4ebUMC7a4M:&ved=0CAUQjRw&url=http%3A%2F%2Fmedicineworld.org%2Fmedicine%2Fneurology%2Fhydrocephalus.html&ei=WjwmUpm1EMrNkgWI8oC4BA&bvm=bv.51495398,d.dGI&psig=AFQjCNEWPB_7Bcx8vIe6Il718G06ZNspVw&ust=1378323834945266

Intracranial infections

Abscess – extra or intra cranial

Extra : look for sinusitis, thrombophlebitis, postop

Intra: look for distant source

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=JpOfeAoMkRYj8M&tbnid=KL2Q7dPUKJxCGM:&ved=&url=http%3A%2F%2Fwww.medscape.com%2Fviewarticle%2F581536_8&ei=aD0mUpaLC9H3lAXY_ICYCg&bvm=bv.51495398,d.dGI&psig=AFQjCNGx1gR8qoPP8yCzzvfd4IYTLf59Bw&ust=1378324200526496

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=4O63j9pWul42aM&tbnid=MAYVncfoKnvJCM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.pediatricsconsultant360.com%2Fcontent%2Fheadache-secondary-epidural-abscess&ei=MUQmUq60FMfjkAWE74GgBg&bvm=bv.51495398,d.dGI&psig=AFQjCNF2f5Gpq7qG45H1s5DN61eBvTwU5g&ust=1378325932423876

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=4O63j9pWul42aM&tbnid=MAYVncfoKnvJCM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.pediatricsconsultant360.com%2Fcontent%2Fheadache-secondary-epidural-abscess&ei=MUQmUq60FMfjkAWE74GgBg&bvm=bv.51495398,d.dGI&psig=AFQjCNF2f5Gpq7qG45H1s5DN61eBvTwU5g&ust=1378325932423876

Nerve wreck…..

Describe the lesion…

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=KbACqxSGxp74AM&tbnid=uppaRxKvdWeGFM:&ved=0CAUQjRw&url=http%3A%2F%2Fthetenwekfiles.wordpress.com%2F2012%2F09%2F07%2Fchronicles-of-casualty%2F&ei=Sz4mUsbLN8iDlQWFpoCYAw&bvm=bv.51495398,d.dGI&psig=AFQjCNGx1gR8qoPP8yCzzvfd4IYTLf59Bw&ust=1378324200526496

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=g3mxAX025x6pUM&tbnid=W9c7Sa0yB3TL2M:&ved=0CAUQjRw&url=http%3A%2F%2Fconfusedcartoon.blogspot.com%2F2010%2F04%2Fpink-face-of-confused-cartoon.html&ei=WUAmUtGTGIH1kQW2oIEY&psig=AFQjCNFmcJIpaEzj3aRTn6ZtVgFQUHxIQA&ust=1378324880847594

Fischer grade for SAH in image

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=dtMvVeipgsEy7M&tbnid=0aJeVbKg6LHU5M:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.neurology.org%2Fcontent%2F78%2F8%2Fe54%2FF1.expansion.html&ei=wD4mUtyOPMynkAWL4oHgCg&bvm=bv.51495398,d.dGI&psig=AFQjCNF82OkXpcl6s3b4qjV2MoWWLu7gBA&ust=1378324495533101

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=oRGwtAmDoau4jM&tbnid=p2g8TkmEOEXr5M:&ved=0CAUQjRw&url=http%3A%2F%2Fleanmeanwritingmachine.wordpress.com%2F2013%2F05%2F18%2Fhindsights%2F&ei=pUAmUvqtD8yxkgWe1ICYBA&psig=AFQjCNFmcJIpaEzj3aRTn6ZtVgFQUHxIQA&ust=1378324880847594

Please describe the pathology..

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=D8xU4Q3xHDVL6M&tbnid=5IkGXbpTEBxJmM:&ved=0CAUQjRw&url=http%3A%2F%2Feducation.vrad.com%2F&ei=sD8mUtygFMPKkwWuh4DoCg&bvm=bv.51495398,d.dGI&psig=AFQjCNGOJ1LFKIU4lkKUboz8Zb3vgffqHQ&ust=1378324677784139

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=zXDP4L4ISSD0uM&tbnid=HK2ad3ZUKdLYXM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.brightsideofthesun.com%2F2010%2F2%2F18%2F1316556%2Fsnap-poll-amare-staying-put-happy&ei=YEEmUv7IGcXmkgXXhYHQBQ&psig=AFQjCNFmcJIpaEzj3aRTn6ZtVgFQUHxIQA&ust=1378324880847594

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=zXDP4L4ISSD0uM&tbnid=HK2ad3ZUKdLYXM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.brightsideofthesun.com%2F2010%2F2%2F18%2F1316556%2Fsnap-poll-amare-staying-put-happy&ei=YEEmUv7IGcXmkgXXhYHQBQ&psig=AFQjCNFmcJIpaEzj3aRTn6ZtVgFQUHxIQA&ust=1378324880847594

Thank you..

Have a great day!!

dr a gazdar 04/09/2013 interpretation of ct brain- neuro surgical prospective

Documents

cerebellum slide

evolution slide

image slide

allergy slide

lesion slide

undisplaced slide

occipital lobe slide

fischer grade slide