lectura sistemática del tc de cráneo
TRANSCRIPT
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LECTURA SISTEMÁTICACT DE CRÁNEO
José David Albillo Labarra
MIR Radiodiagnóstico
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Organización del S.N.
• SN– SNC protegido
• Encéfalo cráneo• Médula espinal
columna vertebral
– SNP• Enlace entre el SNC y
las estructuras periféricas.
• Nervios craneales*• Nervios espinales*
– Plexo braquial– Plexo lumbosacro
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Organización del S.N.
• Encéfalo– HEMISFERIOS– Diencéfalo– Tronco y pares
craneales– Cerebelo
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Organización del S.N.
• Hemisferios– Sustancia gris
• Cuerpos neuronales• Superficie hemisferios
cerebrales = corteza • Cuerpos neuronales
subcorticales
– Sustancia blanca subcortical
• Axones• Mielinizados*
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Recuerdo anatómico
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SURCO CENTRALAnt: LFPost: LP
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SURCO P-OAnt: LPPost: LO
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TENTORIOCraneal: LOCaudal: cerebelo
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SURCO LAT/CISURA SILVIOCraneal: LPCaudal: LT
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LÓBULO INSULARO INSULA
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Organización del S.N.
• Hemisferios– Sustancia gris
• Cuerpos neuronales• Superficie hemisferios
cerebrales = corteza • Cuerpos neuronales
subcorticales– Nu. Base– claustro
– Sustancia blanca subcortical
• Axones• Mielinizados*
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Recuerdo anatómico
• Núcleos de la base– Caudado (1)
• Cabeza• cola
– Palido (2)– Putamen (3)
– 1 + 3 = estriado– 2 + 3 = lenticular.
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Organización del S.N.
• Hemisferios– Sustancia gris– Sustancia blanca
subcortical• Fibras de proyección
descendente– Centro semioval
– Corona radiada
– Capsula interna, externa y extrema
• Fibras comisurales• Fibras de asociación
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CENTRO SEMIOVAL HASTA LA APARICIÓN DEL VENTRÍCULO LATERAL
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CORONA RADIADA DESDE LA APARICIÓN DEL VL HASTA LOS Nu. BASE
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CAPSULA DESDE LA APARICIÓN DE LOS Nu. BASE
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Organización del S.N.
• Hemisferios– Sustancia gris– Sustancia blanca
subcortical• Fibras de proyección
descendente• Fibras comisurales
– Cuerpo calloso
• Fibras de asociación
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Cuerpo calloso
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Cuerpo calloso
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Organización del S.N.
• Hemisferios– Sustancia gris– Sustancia blanca
subcortical• Fibras de proyección
descendente• Fibras comisurales• Fibras de asociación
– cíngulo
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Cíngulo
• Empieza en el área paraolfatoria.
• Se extiende rodeando el cuerpo calloso, el área parahipocámpica y el uncus.
• Forma parte del sistema límbico.
• Conecta lóbulos F,P y T.
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Organización del S.N.
• Encéfalo– Hemisferios– DIENCÉFALO– Tronco y pares
craneales– Cerebelo
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Organización del S.N.
• Diencéfalo (de dorsal a ventral)– Glándula pineal y
cuerpos geniculados– Tálamo– Hipotálamo tallo
hipofisario hipófisis
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T
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T
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T
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T
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T
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TH
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H
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H
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H
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H
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H
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H
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T
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T
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T
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Glandula hipofisaria.
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Glandula hipofisaria.
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Organización del S.N.
• Encéfalo– Hemisferios– Diencéfalo– TRONCO Y PARES
CRANEALES– Cerebelo
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Pares craneales y tronco
• I- bulbo olfatorio• II par
– N.óptico– Quiasma– Tracto óptico
• Tronco
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I parBulbo olfatorio en giro recto
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II parN. óptico
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II par
Glandula hipofisaria.
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Pares craneales y tronco• Tronco
– Vías sensitivas↑ y motoras ↓– Nu. Sensitivo V.– Mesencéfalo
• Lámina cuadrigémina• Pedúnculos cerebrales• Nu. III y IV par.• Nu. Rojo*• Centro de control de la
mirada vertical.– Puente
• Nu. Vm, VI, VII y VIII• Pedúnculos cerebelosos
medios.– Bulbo
• Nu. IX, X, XI y XII. • Nu. Vestibulares*.
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MsPedúnculo cerebral
Lámina cuadrigémina
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Pte
Pedúnculo cerebeloso
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Pte
VII y VIII desde APC a conducto auditivo interno
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Organización del S.N.
• Encéfalo– Hemisferios– Diencéfalo– Tronco y pares
craneales– CEREBELO
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Cerebelo
• Cerebelo– Vermis central– Hemisferio periféricos– Pedúnculos cerebelos
• Superior - Ms• MEDIO – PTE (único
visible)• Inferior – bulbo
– Tentorio del cerebelo
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vermis
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Hemisferio
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Pedúnculo cerebeloso MEDIO
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Sistema ventricular*
• Ventrículo lateral– Asta anterior– Asta temporal
• AgujeroS de Monro• III par• Acueducto de Silvio• IV Vlo• Conducto central
medular
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Sistema ventricular
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VL
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Agujero de Monro
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III VLO
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Acueducto de Silvio
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IV VLO
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Conducto central medular
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Cisternas
De caudal a craneal– cisterna magna o
cerebelobulbar posterior– cisterna pontina y
pontocerebelosa– pentágono de la cisterna
basal– cisterna interpeduncular
y (cuadrigémina y ambiens)
– cisterna insular
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Cisterna magna o cerebelobulbar posterior
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Cisterna pontina y pontocerebelosa
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Pentágono de la cisterna basal
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Cisterna interpeduncular
Cisterna cuadrigémina
Cisterna ambiens
Cisterna insular
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CIV
• Craneo con CIV– 80 cc de Iohexol 300– 2.5cc/seg– Retraso 60 seg– VER SENOS VENOSOS!!!!!!!
• Angio TC cerebral – Polígono de Willis– 80 cc de Iohexol 350– 4cc/seg– Retraso 23 seg.
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A. vertebral
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A. basilar
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ACI
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ACP
ACM
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ACA
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Sistema de drenaje
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Seno longitudinal superior
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Seno recto
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Confluencia de los senos
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Seno transverso
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Seno sigmoide
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Seno sigmoide
Vena yugular
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Ojo
– globo ocular– glándula lagrimal– vena oftálmica– nervio óptico– grasa retroorbitaria– fisura orbitaria
superior.
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Glándula lagrimal
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Vena oftálmica
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Vena oftálmica
Fisura orbitaria superior
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Nervio óptico
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Ventana Isquemia
• “Forzar ventana”
• W: 30
• L: 30
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Ventana hemorragia
• W: 160
• L: 40
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Hueso
• Huesos• Senos
– Frontal, etmoidal, esfenoidal
• Antro y celdillas mastoideas
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En resumen…
• SN– Hemisferios
• sustancia gris– Cx cerebral– cuerpos neuronales subcorticales
• Sustancia blanca: fibras de proyección, de asociación y comisurales– Diencéfalo
• Gl pineal, cuerpos geniculados, Talamo, HipoT, tallo hipofisario y gl. hipofisaria.
– Pares craneales I y II y tronco– Cerebelo
• Sistema ventricular• Cisternas• Vasos (arterias y venas)• Hueso y senos• Ojo
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A la hora del informe…• Número• características
– sólida/ quística– infiltrante/ localizado– necrosis/ calcificación/ hemorragia
• Localización– intraaxial/ extraaxial/ intraventricular– supratentorial/ infratentorial– cortical/ subcortical/ difuso– áreas anatómicas
• Extensión y relación con estructuras vecinas• signos de malignidad
– efecto de masa– edema vasogénico– realce, patrón de realce (la captación de contraste no establece el grado tumoral:
hay bajo grados que captan y alto grados que no captan)– mala delimitación de los límites del tumor– multicentricidad
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No olvidar…
• VER LOS PREVIOS!!!!!!