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University Hospitals Case Medical Center
Department of Radiology
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1 – chiasma2 – brainstem3 – frontal sinus4 – orbit
5 – temporal lobe (middle cranial fossa)6 – mastoid air cells7 – cerebellar hemispheres
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7 – cerebellar hemispheres8 – interhemispheric fissure9 – frontal horn (lateral ventricle)10 – falx cerebri11 – frontal lobe
12 – third ventricle13 – quadrigeminal plate19 - thalamus20 – caudate nucleus21 – basal ganglia
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8 – interhemispheric fissure9 – lateral ventricle11 – frontal lobe14 – septum pellucidum15 - sulci
16 – central sulcus17 – chorioid plexus18 – occipital lobe22 – parietal lobe
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Extra-axial hemorrhage Epidural hematoma Subdural hematoma Subarachnoid hemorrhage
Intra-axial hemorrhage Intraparenchymal hemorrhage Intraventricular hemorrhage
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Hemorrhage in the potential space between the inner table of the skull and dura matter
Causes Blunt trauma - injury to middle meningeal
artery/vein 95% associated skull fracture
Signs High-density, Extra-axial Biconvex lens-shaped mass Does NOT cross sutures CAN cross tentorium
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Hemorrhage in the potential space between the dura mater and the arachnoid space
Causes Damage to bridging veins that cross from the
cortex to the venous sinuses of the brain Deceleration injuries (MVA) Falls (older patients)
Signs High-iso-low density
Depends on acuity Concave, crescent shaped CAN cross sutures Does NOT cross midline
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Hemorrhage into the subarachnoid space Between the pia and arachnoid membranes
Causes Arteriovenous malformation Aneurysm rupture Trauma
Signs Hyperdense Within the sulci
and basal cisterns Intraventricular
blood
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Hemorrhage within the brain parenchyma Causes
Hypertensive/Hemorrhagic Stroke Trauma Blood Vessel abnormalities
Arteriovenous Malformation Aneurysm Rupture
Intracranial Neoplasm Cerebral Amyloid Angiopathy Coagulopathy
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Signs Well demarcated area of high attenuation Surrounded by hypoattenuation
Edema Associated mass effect
Compression of ventricles Effacement of sulci Midline shift Subtentorial herniation
Can have intraventricular blood
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Trauma - Closed head injury Coup (Point of impact)
Shearing of small intracerebral vessels Countercoup (Opposite the point of impact)
Acceleration/deceleration injuries Brain propels in the opposite direction
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Hypertensive Hemorrhagic Stroke 15% of strokes Location
Basal ganglia, thalamus, pons, cerebellum
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Hemorrhage in the ventricular system Cause - Breakthrough bleeding
Brain contusion or subarachnoid hemorrhage Signs
Most common location Occipital horns (lateral ventricles)
Can cause obstructing hydrocephalus
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Intra-axial mass Metastasis
Primary intra-axial mass - ADULTS Glioblastoma multiforme
Primary intra-axial mass – CHILDREN Medulloblastoma (PNET)
Extra-axial mass Meningioma
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Most common intra-axial mass Primary Malignancies
Lung, Breast, Melanoma Signs
Well-defined Near Gray-White Junction Multiple or Solitary Surrounding edema Enhances with contrast
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SOLITARY MULTIPLE
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Gliomas are the most common primary intra-axial malignancy in adults GBM – most common glioma
Poor prognosis Male (age 65-75) > Female Signs
Supra-tentorial Necrotic and Infiltrative Cross midline – “butterfly” glioma Enhances with contrast Significant vasogenic edema, mass effect
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Most common primary intra-axial tumor in children
Primitive neuroectodermal tumors (PNET) Male > Female Peak age 3-5 years Signs
Infratentorial – Cerebellum Effacement of the 4th ventricle, basal cisterns
Hydrocelphalus Hyperdense Necrosis +/- Calcifications Enhances with contrast
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Most common extra-axial mass Benign - Slow growing – good prognosis Middle-aged Female > Male Association - NF-2 Signs
Hyperdense +/- calcifications +/- edema Enhance with contrast Dural Tail
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Questions?
Please read the supplemental article on cervical spine trauma
Neuro quiz will be administered on Thursday at 11:30AM before conference