7/29/2019 Neurological Investigtions-Lecture 15

1/43

Neurological Investigations

Lecture-15

7/29/2019 Neurological Investigtions-Lecture 15

2/43

Learning outcomes

Basic understanding of the commonly

used neurological investigations.

Basic interpretation of normal andabnormal pathologies/structures.

7/29/2019 Neurological Investigtions-Lecture 15

3/43

7/29/2019 Neurological Investigtions-Lecture 15

4/43

7/29/2019 Neurological Investigtions-Lecture 15

5/43

Normal CT of brain

Skull is intact

Ventricles are normal sized

grey versus white distinction is clear

Midline is straight

Sulci are symmetrical on both sides.

7/29/2019 Neurological Investigtions-Lecture 15

6/43

I-EXTRACRANIAL TISSUE

II-CRANIAL BONES

7/29/2019 Neurological Investigtions-Lecture 15

7/43

III-BLOOD

7/29/2019 Neurological Investigtions-Lecture 15

8/43

III-VENTRICULAR SYSTEM

7/29/2019 Neurological Investigtions-Lecture 15

9/43

IV-BRAIN TISSUE

7/29/2019 Neurological Investigtions-Lecture 15

10/43

7/29/2019 Neurological Investigtions-Lecture 15

11/43

DILATED LV-NORMAL V3 & V4=

OBSTRUCTIVE HYDROCEPHALUS

BETWEEN LV & V3

V3

7/29/2019 Neurological Investigtions-Lecture 15

12/43

LV

DILATED LV & V3+NORMAL V4

OBSTRUCTIVE HYDROCEPHALUS BETWEEN V3 & V4

AQUIDUCTAL STENOSIS

7/29/2019 Neurological Investigtions-Lecture 15

13/43

DILATED LV+V3+V4

COMMUNICATING HYDROCEPHALUS

7/29/2019 Neurological Investigtions-Lecture 15

14/43

DILATED SYLVIAN FISSURES=SAH

7/29/2019 Neurological Investigtions-Lecture 15

15/43

7/29/2019 Neurological Investigtions-Lecture 15

16/43

Severe brain trauma: non-

helmeted motorcycle rider

7/29/2019 Neurological Investigtions-Lecture 15

17/43

Epidural hematoma

7/29/2019 Neurological Investigtions-Lecture 15

18/43

Subarachnoid Hemorrhage

Blood shows white on CT.

Anterior Communicating Artery

aneurysm has burst, flooding the

basal structures under the brainoutside the brain parenchyma, but

will occasionally empty into a

Ventricle as it has on the left here

(see fluid level). Note typical

bat wing shape just above themid-brain (green arrow).

7/29/2019 Neurological Investigtions-Lecture 15

19/43

Severe Subarachnoid

HemorrhageSevere hemorrhage and probable

clotting and obstruction causing

hydrocephalus. Pooroutcome

Likely.

7/29/2019 Neurological Investigtions-Lecture 15

20/43

Acute subdural with contusion

and edema on left sideRed arrow- acute blood between dura

and brain.

Green arrow- brain contusion withsubarachnoid features.

Edema shows as shift of midline toward right side.

7/29/2019 Neurological Investigtions-Lecture 15

21/43

Subdural hematoma

7/29/2019 Neurological Investigtions-Lecture 15

22/43

Chronic Subdural with new

contusion on left parietalIf not resolved, acute subdural turns

into chronic hygroma, consistency of

crankcase oil and shows black

(red arrow). New contusion with

subarachnoid and parenchyma

features shown by green arrow.

7/29/2019 Neurological Investigtions-Lecture 15

23/43

Intra cerebral haemorrhage

7/29/2019 Neurological Investigtions-Lecture 15

24/43

Midline shift

7/29/2019 Neurological Investigtions-Lecture 15

25/43

Big bland stroke on right and

craniotomy for decompressionOther strokes progress to severe brain

edema 3 - 5 days post stroke and

require surgical decompression.Note cranium removed on right side to

make room for brain edema. CT shows

bland stroke as dark contrast.

Temporal lobe is sometimes

also removed on ipsalateral

side to make room for edema.

Humans can live normally with only

one temporal lobe.

7/29/2019 Neurological Investigtions-Lecture 15

26/43

Stroke (post craniotomy for

decompression)

Big bland stroke on left, with

craniotomy and replacement

of skull fragment (green arrow).

7/29/2019 Neurological Investigtions-Lecture 15

27/43

Intraparenchymal bleed into

ventricles

7/29/2019 Neurological Investigtions-Lecture 15

28/43

infarction

7/29/2019 Neurological Investigtions-Lecture 15

29/43

Intraventricular bleed

This was a young

person who eventually

went on to rehab

7/29/2019 Neurological Investigtions-Lecture 15

30/43

Normal MRI

MRI shows alterations between water

and fat content of tissues. Gives a high

resolution view of brain, especially stroke,

appearing as white contrast

which sometimes can take as long as

8 hours to show up.

7/29/2019 Neurological Investigtions-Lecture 15

31/43

Strokes show up faster on

MRI than CT

7/29/2019 Neurological Investigtions-Lecture 15

32/43

MRI and CT views of the same

whole R. hemispherical infarctSome very big strokes settle down and dont require surgical decompression.

This man opens his eyes to verbal commands.

7/29/2019 Neurological Investigtions-Lecture 15

33/43

Same bleed into brain stem on

CT (right) and MRI (left)

7/29/2019 Neurological Investigtions-Lecture 15

34/43

New stroke on T2 FLAIR

New strokes usually

show up as white on T2.

7/29/2019 Neurological Investigtions-Lecture 15

35/43

shows accumulated blood

Blood shows white on T2 Flair Left).black on MPGR (Right),

7/29/2019 Neurological Investigtions-Lecture 15

36/43

Old stroke

Usually cystify and

develop firm borders

7/29/2019 Neurological Investigtions-Lecture 15

37/43

Cerebral abscesses

7/29/2019 Neurological Investigtions-Lecture 15

38/43

Brain tumors: Glioblastoma

Multiforme Glios are rapid growing and cause death by brain compression.

7/29/2019 Neurological Investigtions-Lecture 15

39/43

Giant meningioma

Meningiomas are slow growing and have discrete borders. Most amenable

to operative resection.

7/29/2019 Neurological Investigtions-Lecture 15

40/43

MRI Side views: Chiari

malformationSome believe cranium too small

for brain, Others believe the

foramen magnum is malformed.

Symptoms of headache, ataxia

and nystagmus with progressive

pressure on brain stem.

7/29/2019 Neurological Investigtions-Lecture 15

41/43

Hydrocephalus

7/29/2019 Neurological Investigtions-Lecture 15

42/43

CT angio of giant unruptured

MCA aneurysm

7/29/2019 Neurological Investigtions-Lecture 15

43/43

The end