INTRACRANIAL HEMATOMAS and

HEAD CT.SCAN

Presenters: Anwar Wardy WDept. Neurology FK UMJ

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

Objective:•To explain how head and intracranial hematomas view on CT.SCAN

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

Cerebral Blood Supply dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

Cerebral Blood Supply – side view

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

Middle Cerebral Artery

http://www.strokecenter.org/education/ais_vessels/ais049b.html

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

Posterior Cerebral Circulation

http://www.strokecenter.org/education/ais_vessels/ais049c.html

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

Circle of Willis •Sits at the base of

the brain • Joins the anterior

and posterior circulation

• Important route of secondary or collateral circulation

•Most common site for congenital aneurysm

http://www.strokecenter.org/education/ais_vessels/ais048.html

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

Location

http://www.nlm.nih.gov/medlineplus/ency/imagepages/18009.htm

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

http://www.meddean.luc.edu/lumen/meded/Neuro/neurovasc/navigation/cow.htm

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

The Brain

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

Frontal Lobe•Blood supply - ACA and MCA•Major functions:

▫personality, behaviour▫motor function▫judgement/problem solving▫micturation▫expressive speech - Broca’s

word formation, articulation andspeech production

▫concentration, reasoning

Neuroanatomy and Cerebral Circulation Review, West GTA Stroke Network, 2003

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

Parietal Lobe

•Blood supply – ACA, MCAand PCA

•Major functions:▫sensory function▫body part awareness▫visual spatial information

Neuroanatomy and Cerebral Circulation Review, West GTA Stroke Network, 2003

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

Temporal Lobe•Blood supply - MCA and PCA•Major Functions:

▫understanding speech -Wernickes

▫visual, olfactory and auditory perception

▫learning, memory, emotional affect

Neuroanatomy and Cerebral Circulation Review, West GTA Stroke Network, 2003

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

Occipital Lobe

•Blood supply - MCA,PCA•Major Functions:

▫primary visual area▫some visual reflexes▫involuntary smooth eye

movements▫recognition & identification

of objects

Neuroanatomy and Cerebral Circulation Review, West GTA Stroke Network, 2003

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

Cerebellum•Blood supply -

Vertebrobasilar•Major Functions:

▫control of fine motor movement

▫coordinates muscle groups

▫maintains balance, equilibrium

Neuroanatomy and Cerebral Circulation Review, West GTA Stroke Network, 2003

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

Brain Stem

•Blood supply - PCA & Vertebrobasilar

•Major divisions - midbrain, pons, medulla

•Houses CN III-XII•Serves as a pathway•Reticular Activating

System

Neuroanatomy and Cerebral Circulation Review, West GTA Stroke Network, 2003

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

Motor & Sensory Functiondept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

Types of intracranial hematomas.The brain is covered by 3 membranes:

• the dura mater which is the outermost and lies just beneath the skull,• the arachnoid mater which is the intermediate layer,• the pia mater which is firmly adherent to the brain tissue.

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

•Epidural hematoma

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

Ischemic Stroke – CT scandept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

•Subdural hematoma

Subdural Hematoma

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

Hemorrhagic Stroke CT scan

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

3. Intracerebral hematomas.• blood clots within the brain

tissue. • can result from one or more

contusions and this is followed by local oedema .

• may increase in size, causing increased intracranial pressure and intracranial herniations of the brain.

• Symptoms depend on the area of the brain parenchyma affected.

Intracerebral Hematoma

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

Ischemic Penumbra• Area around infarct• Infarcted brain tissue

dies quickly - brain cells within the penumbra remain viable for several hours after stroke

• Penumbra cells supplied with blood by collateral arteries

• Reperfusion important as circulation becomes inadequate with time

dept.neurology-ct.scan anwar wardy w, DR dr SpS, DFM

Possible consequences of intracranial hemorrhages

• Raised pressure inside the skull, presents with headache, impaired consciousness, nausea and vomiting, papilloedema.

• Intracranial shift or herniation

• Posttraumatic epilepsy

• Posttraumatic hydrocephalus

• Psychiatric disorders

• Brain swelling

Note:• For people taking anticoagulants e.g aspirin, the possibility of

developing intracranial hematomas from minor head injuries is increased.

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM

References:• R .M acsw een,K .W haley ,M uir ’s text book of

pathology,13th edition pages 814-817.• Kumar,Abbas,Fausto,Aster,Robbins&Cotran pathologic

basis of disease,8th edition,pages 1287-1290.• http://www.merck.com/mmpe/sec21/ch310/

ch310a.html#sec21-ch310-ch310a-253• Microsoft student with Encarta encyclopedia 2008

(hematomas)• http://www.merck.com/mmhe/sec06/ch087/

ch087e.html• http://strokedoc.typepad.com/stroke_doc/2006/01/

intracerebral_h.html

dept.neurology-ct.scan

anwar wardy w, DR dr SpS, DFM