blok brain and mind

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  • Dr Hj Asmah Yusuf Sp.RadDr Evo Elidar Hrp Sp.Rad

  • The SkullThe standard projections are : 1. The lateral view

    2. The PA view

  • Routine method of study of Skull X rayExamine : the inner and outer tableExamine trabeculasi and densitas boneExamine: SuturesExamine :Vascular markingsExamine : sellaExamine : intracranial kalsifikasi

  • Normal intracranial kalsifikasi1.Pineal2.Habenula3.Choroid plexus4.Dura (falx,tentorium).5.Ligaments (petroclinoid and interclinoid)6.Pacchionian bodies7.Basal ganglia and dentate nuclei8.Pituitary gland9.Lens

  • Normal Skull FilmsAP Skull-X RayLateral Skull-X Ray

  • AP view

  • Lateral view

  • Abnormal Skull1.Fracture.2.Metastasis3.Congenital disorders4.Kalsifikasi5.Raised intracranial pressure

  • MetastasisLesi lytik

  • Lesi lytik luas

  • Multiple Myeloma

  • Congenital disordersScaphocephaly

  • Scaphocephaly

  • Scaphocephaly

  • Raised intracranial pressureHydrocephalus

  • Raised intracranial pressure

  • Computed tomography

  • CT schematic

  • INDICATION

    1.HEAD INJURY2.CEBROVASLULAR DISEASES (CVD)3.BRAIN TUMOR4.CEREBRAL INFECTION5.CONGENITAL DISORDER6.CEREBRAL ATROPHY OR 7.DEGENERATIVE DISEASES

  • THE BRAIN LAYER ANATOMYSKINBONE EPIDURALDURAMATER SUBDURALARACHNOID SUBARACHNOIDPIAMATER

  • THE

    BRAIN

    LAYER

    ANATOMY

  • ANATOMY BRAIN

  • HEAD Scan NORMAL

  • High density (hiperdens) : densitas lesilebih tinggi dari jaringan normal.

    Isodens :densitas lesi sama dengan jaringan sekitarnya

    Low density(hipodens): densitas lesi lebihrendah dari jaringan normal

  • Skull Fractures-Associated with pneumocephaly (air in head) rarely can develop tension pneumocephalus-Only significant if open to air,cosmetically disfiguring(greater than full thickness displacement) or

  • associate with air sinus (for risk of infection) or underlying bleed (epidural hematom)Treatment ONLY for cosmetic orprevention of infection ( if open to air or to an air sinus

  • Fracture

  • Intracranial Hemorrhage Intracranial hemorrhage can be classified according to the space occupied by the blood: Epidural Hemorrhage Subdural Hemorrhage Subarachnoid Hemorrhage Intraparenchymal Hemorrhage Intraventricular Hemorrhage

  • Intracranial Hemorrhage: Types

  • Epidural HemorrhageBetween skull and dura, limited by periosteal layer so stops at sutures of skull and thus biconvex (lens) shapedDue to middle meningeal artery tear,often associated with skull fracture

  • EPIDURAL

    HEMATOM

  • Subdural HematomaOccur in the 4 As : alcoholic,anti- coagulant-treated,aged and abuse victims (shaken baby syndrome)Between dura and archnoid of brain Follow contour of brain so Crescent Shape.Due to cortical bridging vein tear as hemoglobin broken down,blood changes color on CT scan and can be easily mised (see sub acute )

  • Usually patients with subdural hematoma have worse Brain injury than epidural hematomaSmall size bleeds can be spontaneusly absorbed by the body,but if midline shift is presentSurgical evacuation

  • Subdural HemorrhageACUTESUB ACUTECHRONIC

  • Subarachnoid Hemorrhage Subarachnoid hemorrhage is generally feathery in appearance on CT scan, as itsmixed in with cerebrospinal fluid

  • The MOST COMMON cause of subarachnoid haemorrhage is 1.Trauma 2.The 2 nd and 3 rd most common causes are aneurysms or arteriovenous malformations No intervention is generally performed for subarachnoid hemorrhage alone.

  • However ,subarachnoid hemorrhage can cause hydrocephalus (due to obstruction of CSF flow) or vasospasm (due to ? blood product irritating a vessel) in delayed fashion

  • SAH

  • SAH

  • Intraparenchymal Hemorrhage Called Contusions in trauma bruising of the brainCoup ( direct injury of brain impact) or contrecoup (injury due to brain hitting skull opposite side as skull decelerates but brain doesnt)-usualy temporal/frontal.

  • -Can develop extreme amount of edema or blossom,so must follow closely with repeat CT scans-Can be caused by hypertensive hemorrhage in characteristic locations (basal ganglia,thalamus pons, cerebellum) or arteriovenous malformations

  • -In older patients (> 60 ) can be caused by cerebral amyloid angiopathy, usually in a lobar location-Surgical evacuation if excessive mass effect

  • Intraparenchymalhemorrhage

  • Intraventricular Hemorrhage-Usually due to extension of intraparenchymal bleed (most Commonly from hypertension-Treatment depends on whether hydrocephalus develops then patients may need ventriculostomy placement

  • Intraventricularhemorrhage

  • STROKE Stroke is disease cerebrovasculer (venous of brain) which marked with death tissue brain (infarct cerebral) happened because the less of oxygen and blood strem to brain.

  • Stroke divided to become two typeStroke ischaemi blood stream to brain is desisted by artherosclerotic (heaping of cholesterol at venous wall) or blood clot which have corking an vein to brain2.Stroke hemorrhage venous broken causing pursue normal blood stream and blood seep into area brain in the breakdown

  • Cerebral infarct

  • Infarct pons

  • Cerebral hemorrhage

  • HydrocephalusNormal CSF flow is from lateral ventricles to third ventricle, via aquaduct silvii to fourth V, then through foramina of magendieand luschka to subarachnoid space,then absorption via arachnoid granulations into the superior sagittal sinus

  • -Any obstruction on this pathway can cause hydrocephalus -Treatment is temporarily by diverting spinal fluid via ventriculostomy catheter permanently,a shunt ( e.g. ventriculoperitoneal , or VP shunt)

  • HYDROCEPHALUS

  • BRAIN TUMOURS

  • BRAIN TUMOURS

  • Brain Tu (pylocytic astrocytoma)

  • Brain tumors

  • Cerebral abscessPada kontras tampak ring enhancement

  • Encephalitis

  • OLEH : Dr Hj. Asmah Yusuf Sp.Rad Dr. Elidar Hrp Sp.Rad

  • MRI Beda CT scan VS MRICTMRIBiaya Mahal Sangat mahalP.Rad sedang - tinggi (-)Prinsip X-ray Magnet & gel radioWaktu Biasa +/- 5 mnt +/- 30 mntSoft tissue tidak baik sangat baikTulang Baik tidak baikPerub-imag (-) images beberapa potongan potongan

  • MRI : Normal brain (axial)

  • MRI : Normal brain (sagital)

  • MRI : normal brain (coronal)

  • MRI ( T 1 and T2)

  • MRI VS CTEncephalitis :11(MRI)3 (CT)Infarct Acute : 82 % 58 %

    CT : -Beberpa jam pertama normal pada : 60 % pasien walau klinis sdh ada -Scan ulang 48 jam setelah stroke area hypodense ( dark)

  • MRI lebih sensitif dibanding CT,Beberaoa menit setelah klinis /sympton Gambaran MRI (+)

  • Cerebral Infarct CTT1 MRIT2 MRI

  • Cerebral infract

  • Encephalitis

  • Encephalitis

  • Subarachnoid hemorrhage

  • Brain tumor (sagital)

  • MRI : Brain tumor

  • Dandy Walker malformation

  • Chiari Malformation type II