CNS Pathology
Download

CNS Pathology

Advertisement
Download Presentation
Comments
saniya
From:
|  
(127) |   (0) |   (0)
Views: 134 | Added: 05-07-2012
Rate Presentation: 1 0
Description:
INFLAMMATORY DISEASE OF CNS. . Meningitis. Inflammation fo the meningeal coverings of the brain and spinal cordCan be caused by Bacteria, virus and other organisms via blood or lymphTrauma, pentrating wounds or adjacent structures infectedBacterial is most common (can cause hydrocephalus). Pa
CNS Pathology

An Image/Link below is provided (as is) to

Download Policy: Content on the Website is provided to you AS IS for your information and personal use only and may not be sold or licensed nor shared on other sites. SlideServe reserves the right to change this policy at anytime. While downloading, If for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.











- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -




1. CNS Pathology Fall 2009 Final

2. INFLAMMATORY DISEASE OF CNS

3. Meningitis Inflammation fo the meningeal coverings of the brain and spinal cord Can be caused by Bacteria, virus and other organisms via blood or lymph Trauma, pentrating wounds or adjacent structures infected Bacterial is most common (can cause hydrocephalus) There are three forms of pus forming (pyogenic) bacterias. They are carried to the meninges via the ear, frontal sinus or respiratory tract. Tubercle bacillus is another bacteria that can cause meningitis but it is not pus forming and is more difficult to diagnose. It does not have the same acute symptoms and the other three types. It is usually spread from the lung.There are three forms of pus forming (pyogenic) bacterias. They are carried to the meninges via the ear, frontal sinus or respiratory tract. Tubercle bacillus is another bacteria that can cause meningitis but it is not pus forming and is more difficult to diagnose. It does not have the same acute symptoms and the other three types. It is usually spread from the lung.

4. Pathogens causing Meningitis ___________________ Chronic meningitis Often associated with AIDS and immunodepressant drug therapy ___________________ Viral meningitis can be caused by mumps, poliovirus and herpes simplex ___________________ Most common Bacteria release toxins that destroy meningeal cells stimulating immune & inflammatory reactions

5. Pathogens causing Meningitis Fungi Chronic meningitis Often associated with AIDS and immunodepressant drug therapy Virus Viral meningitis can be caused by mumps, poliovirus and herpes simplex Bacteria Most common Bacteria release toxins that destroy meningeal cells stimulating immune & inflammatory reactions

6. Acute Meningitis Clinical Symptoms Fever Headache Stiff neck Vomiting Changes in LOC Severely ill in 24 hours Rash Chronic symptoms are the same but occur over weeks Chronic meningitis The symptoms are similar to that of acute meningitis but is happens over weeks rather than days. It progresses slowly but can still be fatal.Chronic meningitis The symptoms are similar to that of acute meningitis but is happens over weeks rather than days. It progresses slowly but can still be fatal.

7. Diagnosis of Meningitis Brain CT Rule out contraindications to do a spinal tap Spinal tap LP to remove CSF to send to lab Sometimes MRI is used Is most sensitive modality for demonstrating pia and arachnoid Treatment includes: antibiotics and if secondary to encephalitis: antiviral drugs Can be lethal in a short amount of time so accurate fast diagnosis is very important. First brain CT is used to determine if there are any abnormalities such as a brain mass, that are contraindicated for a LP. Can also be useful in seeing if there are any fracture and brain abscess. Spinal tap is done to get lab results as to which bacteria is responsible for the large amounts of pus cells. MRI Contrast enhanced can identify subarachnoid inflammation and inflammation of the mastoids or sinuses. Can be lethal in a short amount of time so accurate fast diagnosis is very important. First brain CT is used to determine if there are any abnormalities such as a brain mass, that are contraindicated for a LP. Can also be useful in seeing if there are any fracture and brain abscess. Spinal tap is done to get lab results as to which bacteria is responsible for the large amounts of pus cells. MRI Contrast enhanced can identify subarachnoid inflammation and inflammation of the mastoids or sinuses.

8. Radiographic Appearance Initially meninges show vascular congestion, edema and minute hemorrhages MRI and CT scans could appear normal if appropriate therapy is done right away Contrast enhanced MRI is the most sensitive modality for demonstrating enhancement of the two innermost layers of the meninges: pia and arachnoid and subarachnoid distention. Contrast enhanced MRI is the most sensitive modality for demonstrating enhancement of the two innermost layers of the meninges: pia and arachnoid and subarachnoid distention.

9. Encephalitis Infection of the brain tissue that is viral May occur subsequent to chickenpox, small pox, influenza and measles May be caused by mosquitoes and herpes Survival rates depend of cause of the disease (can be fatal) 30% of cases in children When caused by herpes it is often fatal

10. Encephalitis MRI is modality of choice Results in cerebral edema and hemorrhagic lesions More serious than meningitis because it frequently develops permanent neurologic disabilities The viral infection results in cerebral edema and numerous hemorrhagic spots scatted throughout the cerebral hemispheres, brain stem and cerebellum.The viral infection results in cerebral edema and numerous hemorrhagic spots scatted throughout the cerebral hemispheres, brain stem and cerebellum.

11. Encephalitis: Symptoms and Treatment Symptoms: Headache Malaise Coma Fever Seizures Treatment: Treated with antiviral medications Herpes induced is treated with Acyclovir Interferes with DNA synthesis and inhibits viral replication

12. CONGENITAL DISEASES OF CNS

13. Spinal Bifida Is a congenital disease Bony neural arch that not completely closed Most common in lumbar region May or may not herniate through opening Can range in risk from treatable to life threatening Can be diagnosed in utero With amniocentesis Ultrasound Elevated beta fetoprotein in mother?s blood Bony neural arch that encloses and protects the spinal cord is not completely closed. Bony neural arch that encloses and protects the spinal cord is not completely closed.

14. Types of Spinal Bifida ________________ Only the meninges protrude Local defect of bone & dura ________________ Protrusion of spinal cord ________________ Protrusion of meninges and spinal cord into the skin of the back Most serious ________________ No protrusion of spinal contents Least severe Spinal bifida occulta often accompanied by a depression or dimple, tuft of hair, soft fatty deposits, port wine mole, or a of these over the skin of the spinal defect. Incomplete closure of the neural arch resulting in a gap in the laminae but no protrusion of the spinal contents. M Most frequently L4-L5 and L5-S1.Spinal bifida occulta often accompanied by a depression or dimple, tuft of hair, soft fatty deposits, port wine mole, or a of these over the skin of the spinal defect. Incomplete closure of the neural arch resulting in a gap in the laminae but no protrusion of the spinal contents. M Most frequently L4-L5 and L5-S1.

15. Types of Spinal Bifida Meningocele Only the meninges protrude Local defect of bone & dura Myelocele Protrusion of spinal cord Meningomelocele Protrusion of meninges and spinal cord into the skin of the back Most serious Spinal bifida occulta No protrusion of spinal contents Least severe Spinal bifida occulta often accompanied by a depression or dimple, tuft of hair, soft fatty deposits, port wine mole, or a of these over the skin of the spinal defect. Incomplete closure of the neural arch resulting in a gap in the laminae but no protrusion of the spinal contents. M Most frequently L4-L5 and L5-S1.Spinal bifida occulta often accompanied by a depression or dimple, tuft of hair, soft fatty deposits, port wine mole, or a of these over the skin of the spinal defect. Incomplete closure of the neural arch resulting in a gap in the laminae but no protrusion of the spinal contents. M Most frequently L4-L5 and L5-S1.

16. Radiographic Appearance Can be demonstrated with CT, MRI and myelography Prenatally with ultrasound (in utero) Large bony defects Herniated spinal contents Myelography, CT and MRI can demonstrate the presence of spinal cord or nerve roots within the herniated sac Large bony defects: Absence of laminae Increased interpedicular distance Herniated spinal contents are seen as soft tissue mass posterior to the spine.Myelography, CT and MRI can demonstrate the presence of spinal cord or nerve roots within the herniated sac Large bony defects: Absence of laminae Increased interpedicular distance Herniated spinal contents are seen as soft tissue mass posterior to the spine.

17. Meningomyelocele Most serious Affected PT?s have severe neurologic deficits Paraplegia Diminished control of lower limbs, bladder and bowels Hydrocephalus is common

18. Spinal Bifida Imaging

19. Spinal Bifida Treatment Can be surgically repaired Neurological damage is permanent still and cannot be reversed Most measures are supportive rather than corrective Physical therapy Physical supports Braces Splints If it is possible to fix it surgically it should be fixed, because any opening of the sac to the exterior of the body risks meningeal infection.If it is possible to fix it surgically it should be fixed, because any opening of the sac to the exterior of the body risks meningeal infection.

20. CRANIAL AND SPINAL FRACTURES

21. Cranial Fractures Cerebral fractures usually occurs to fractures of the calvaria of the skull 3 types of cranial fractures _____________- straight and sharply defined Is 80% of all cranial fractures _____________- curvilinear density _____________- Air fluid levels are indicative Hard to diagnosis radiographically

22. Cranial Fractures Cerebral fractures usually occurs to fractures of the calvaria of the skull 3 types of cranial fractures Linear- straight and sharply defined Is 80% of all cranial fractures Depressed- curvilinear density Basilar- Air fluid levels are indicative Hard to diagnosis radiographically

23. Cranial Fractures Location of FX is more important that the extent of the FX If FX crosses artery a bleed can occur causing a hematoma Fx that enters mastoid air cells or sinus can cause an infection that can result in Meningitis Encephalitis

24. Linear Fractures Non branching lines that are intensely radiolucent Vascular markings are occasionally mistaken for fractures Fracture appears more translucent and transverses the full thickness of skull Sutures Vascular markings (venous or arterial) are routinely demonstrated as translucent. This is why they are occasionally mistaken for cranial fractures. A way to distinguish between the two is as follows: A FX appears more translucent than a vascular marking Transverses full thickness of the skull Edges of FX?s may branch abruptly, but they still van be fit together. Venous channels on the other hand cannot be fitted together. As sutures are visible radiographically even after they are closed, they untrained eye may mistake these sutures for cranial fractures. Vascular markings (venous or arterial) are routinely demonstrated as translucent. This is why they are occasionally mistaken for cranial fractures. A way to distinguish between the two is as follows: A FX appears more translucent than a vascular marking Transverses full thickness of the skull Edges of FX?s may branch abruptly, but they still van be fit together. Venous channels on the other hand cannot be fitted together. As sutures are visible radiographically even after they are closed, they untrained eye may mistake these sutures for cranial fractures.

25. Linear Skull FX

26. Depressed Fracture The fractured edges overlap Usually caused by a high velocity impact with a small object Can cause bleeding into subarachnoid space Best demonstrated with CR tangential to the FX

27. Depressed Skull FX

28. Basilar Fracture Very difficult to demonstrate with x-ray Air fluid levels in sphenoid sinuses Clouding of mastoid air cells Often X-table lateral is done to demonstrate this CT & MRI are most often used for this type Basilar fractures are very hard to demonstrate radiographically. An indication of such a FX on x-ray may be suggested by air fluid levels in the sphenoid sinuses or clouding of the mastoid air cells. These are often the only indications of this type of FX with x-ray. CT and MRI are most often used for FX?s of this type and associated soft tissue damage within the skull.Basilar fractures are very hard to demonstrate radiographically. An indication of such a FX on x-ray may be suggested by air fluid levels in the sphenoid sinuses or clouding of the mastoid air cells. These are often the only indications of this type of FX with x-ray. CT and MRI are most often used for FX?s of this type and associated soft tissue damage within the skull.

29. Compression Fracture of spine Most frequent type of injury involving vertebral body Generally occurs in T and L-spine T11- T12 and T12 ? L1 Damage is usually limited to the upper portion of the vertebral body, particularly to the anterior margin Treatment varies depending on the severity of the FX. Sometimes Vertebroplasty or Kyphoplasty are performed. Other times they may recommended rest, anti-inflammatory, analgesics, later followed by P.T.Treatment varies depending on the severity of the FX. Sometimes Vertebroplasty or Kyphoplasty are performed. Other times they may recommended rest, anti-inflammatory, analgesics, later followed by P.T.

30. Compression FX of Spine

31. Compression FX of Spine

32. Hangman?s Fracture FX of the arch of the 2nd c-spine vertebrae Usually accompanied by anterior subluxation of the 2nd and 3rd cervical vertebrae Sometimes called traumatic spondylosis Resulting from acute hyperextension of the head & neck Originally seen commonly in hangings Now seen more for MVA

33. Hangman?s Fracture

34. Hangman?s Fracture

35. Jefferson?s Fracture Comminuted FX of the ring of the atlas First described as a ?burst FX? Generally occurs as a result of severe axial force such as a MVA With this FX particular attn needs to be paid to the transverse longitudinal ligament by reviewing lateral masses on the open mouth odontoid MRI is preferred method for this ligament Involves both anterior and posterior arches and causes displacement of the fragments. Characteristic appearance on frontal radiographs or tomographs is bilateral offset or spreading of the lateral articular masses of the C1 in relation to the surfaces of C2. Involves both anterior and posterior arches and causes displacement of the fragments. Characteristic appearance on frontal radiographs or tomographs is bilateral offset or spreading of the lateral articular masses of the C1 in relation to the surfaces of C2.

36. Jefferson?s Fracture The lateral (outward) displacement of the lateral masses is clearly visible in this radiograph. When C1 is fractured in less than four places, transverse ligament tears are common and can lead to more instability. If the transverse ligament remains intact, there will be no neurologic deficits, and the lateral cervical spine X-ray may appear normal. If the transverse ligament is ruptured, C1 will move forward on C2, and the spinal cord will be compressed The lateral (outward) displacement of the lateral masses is clearly visible in this radiograph. When C1 is fractured in less than four places, transverse ligament tears are common and can lead to more instability. If the transverse ligament remains intact, there will be no neurologic deficits, and the lateral cervical spine X-ray may appear normal. If the transverse ligament is ruptured, C1 will move forward on C2, and the spinal cord will be compressed

37. Jefferson?s Fracture

38. TRAUMATIC DISEASE

39. Cerebral Contusion Is an injury to the brain tissue caused by a movement of the brain within the calvaria after blunt trauma Occurs when brain contacts rough skull surfaces such as orbital floor and petrous ridges Results from a direct blow to the head. This ?bruising? of the brain parenchyma is more serious than a concussion. It is formed by the side of the head where the trauma occurs is called a coup lesion. Characterized by neuron damage, edema, pinpoint punctures or depressions and hemorrhaging. Is an injury to the brain tissue caused by a movement of the brain within the calvaria after blunt trauma Occurs when brain contacts rough skull surfaces such as orbital floor and petrous ridges PT usually loses consciousness and cannot remember traumatic event Persistent LOC over 24 hrs is a coma and can be fatal Subdural and epidural hematomas can occur in conjunction with a contusion and result in increased intracranial pressure that can be life threatening. Results from a direct blow to the head. This ?bruising? of the brain parenchyma is more serious than a concussion. It is formed by the side of the head where the trauma occurs is called a coup lesion. Characterized by neuron damage, edema, pinpoint punctures or depressions and hemorrhaging. Is an injury to the brain tissue caused by a movement of the brain within the calvaria after blunt trauma Occurs when brain contacts rough skull surfaces such as orbital floor and petrous ridges PT usually loses consciousness and cannot remember traumatic event Persistent LOC over 24 hrs is a coma and can be fatal Subdural and epidural hematomas can occur in conjunction with a contusion and result in increased intracranial pressure that can be life threatening.

40. CT appearance of Cerebral Contusion CT scans appear as low density areas of edema and tissue necrosis When IV contrast is used it will enhance several weeks after injury Plays an important role in diagnosis CT scans appear as low density areas of edema and tissue necrosis With or without homogenous density zones reflecting areas of hemorrhage Most common sites of injury are frontal and anterior temporal regions. When IV contrast is used it will enhance several weeks after injury Plays an important role in diagnosisCT scans appear as low density areas of edema and tissue necrosis With or without homogenous density zones reflecting areas of hemorrhage Most common sites of injury are frontal and anterior temporal regions. When IV contrast is used it will enhance several weeks after injury Plays an important role in diagnosis

41. MR of Cerebral Contusion Cerebral edema causes high signal intensity on T2 scans T1 scans may produce high signal regions Diagnosis can also include CT, MRI and PET

42. Cerebral Contusion Clinical symptoms: Drowsiness Confusion Agitation Hemiparesis Unequal pupil size Treatment: PT is hospitalized Prevent shock If there is swelling medication is given to decrease cranial pressure Control edema Drainage of hematoma Surgery is usually not necessary

43. Cerebral Contusion

44. Hematomas Brain trauma often resulting in a hemorrhaging from a ruptured vein or artery Skull does not allow for expansion and pressure forces brain toward open space (foramen magnum) Can result in major consequences & death if not treated quickly If not diagnosed and surgically removed quickly the outcome is fatal due to brain displacement and herniation. Brain trauma often resulting in a hemorrhaging from a ruptured vein or artery Venous bleeding occurs more slowly than arterial bleeding Arterial bleed accumulates fast & causes neurologic symptoms & coma Both can cause edema in the brain and cause an increase in intracranial pressure Skull does not allow for expansion and pressure forces brain toward open space (foramen magnum) Can result in major consequences & death if not treated quickly If not diagnosed and surgically removed quickly the outcome is fatal due to brain displacement and herniation. Brain trauma often resulting in a hemorrhaging from a ruptured vein or artery Venous bleeding occurs more slowly than arterial bleeding Arterial bleed accumulates fast & causes neurologic symptoms & coma Both can cause edema in the brain and cause an increase in intracranial pressure Skull does not allow for expansion and pressure forces brain toward open space (foramen magnum) Can result in major consequences & death if not treated quickly

45. Epidural Hematomas Highest mortality relate of the hematomas Even when treated quickly mortality rate is 30% Results from a torn artery and its branches Most often occurs from a FX of the temporal bone 80% of cases conventional radiograph shows fracture Usually meningeal artery with blood pooling between bones of the skull & dura mater

46. Epidural Hematoma CT shows an increased density generally a small area with sharply convex appearance. Often accompanied by a FX of skull or facial bones.CT shows an increased density generally a small area with sharply convex appearance. Often accompanied by a FX of skull or facial bones.

47. Subdural Hematomas Between the dura mater & arachnoid meningeal layers Caused by blunt trauma to frontal or occipital lobes and can tear subdural veins Pushes brain away from skull across midline (including ventricles)

48. Subdural Hematoma

49. Subdural Hematomas Subacute stage (up to several days) Appears on CT as a decreased density or isodense fluid collection In chronic state (2-3 weeks) The surface of the hematoma becomes concave Delayed coma con occur

50. Symptoms of Hematomas Headaches Agitation Drowsiness Gradual radiograph deficits

51. Treatment of Hematomas In small hematomas without inclination to rebleed Severe cases Less invasive treatment may include In small hematomas without inclination to rebleed the hemorrhage is reabsorbed naturally no treatment is necessary Severe cases Require surgical ligation Evacuation of hematoma to prevent herniation Less invasive treatment may include Drug therapy Intraventricular catheter to remove CSF, which may cause herniation In small hematomas without inclination to rebleed the hemorrhage is reabsorbed naturally no treatment is necessary Severe cases Require surgical ligation Evacuation of hematoma to prevent herniation Less invasive treatment may include Drug therapy Intraventricular catheter to remove CSF, which may cause herniation

52. Degenerative Diseases

53. Herniated Disk Disks act as shock absorbers When young nucleus pulposus contains large amount of fluid to cushion spine With increased age the fluid & elasticity decrease leading to degenerative disease and back pain

54. Herniated Disk May result from either degenerative disease or trauma A weakened or torn annulus is subject to rupture Nucleus pulposus protrudes & compresses spinal nerve roots Can prolapse in any direction, sometimes without pain When it projects posteriorly there is pain and weakening of muscles supplied by those nerves Most commonly occurs is lower cervical & lumbar Lumbar: Most at L4-L5 and L5 ? S1 Cervical: Most at C6 ? C7 Thoracic: T9-T12

55. Herniated Disk

56. Herniated Disk MRI is modality of choice CT and Myelography can also be used

57. Symptoms of Herniated Disk Sudden weak & severe onset of pain Compression of nerve roots in C-spine: Compression in lumbar in L-spine: Sudden weak & severe onset of pain Weakened muscles Compression of nerve roots in C-spine: Cause pain and weakness in neck & upper extremities Compression in lumbar in L-spine: Causes pain in hip, posterior thigh, calf and foot (sciatica) Sudden weak & severe onset of pain Weakened muscles Compression of nerve roots in C-spine: Cause pain and weakness in neck & upper extremities Compression in lumbar in L-spine: Causes pain in hip, posterior thigh, calf and foot (sciatica)

58. Treatment: Herniated Disk Conservative treatment Surgical intervention Conservative treatment: Bed rest, analgesics and muscle relaxants Followed by physical therapy 95% recover is 3 months without surgery Surgical intervention Diskectomy Surgical decompression Spinal fusion Laminectomy Conservative treatment: Bed rest, analgesics and muscle relaxants Followed by physical therapy 95% recover is 3 months without surgery Surgical intervention Diskectomy Surgical decompression Spinal fusion Laminectomy

59. Herniated Disk: Fusion

60. Brain & Spinal Tumors

61. Spinal Tumors Primary tumors as less common is spinal cord than those of the brain Divided into extradural and intradural Intradural further divided into Intramedullary (within spinal cord) Most common are: Astrocytoma & Epenymoma Extramedullary (outside spinal cord) Most common types of primary spinal neoplasm's (>60%) are: Meningiomas and Neurofibromas

62. Symptoms of Spinal Tumors Extramedullary Similar symptoms as a herniated nucleus pulposus Compress nerve roots leading to pain and muscle weakness Intramedullary Can cause progressive paraparesis Sensory loss

63. Extramedullary Spinal Tumors

64. Intramedullary Spinal tumors

65. Imaging of Spinal Tumors MRI is the modality of choice Conventional radiography Can demonstrate bony destruction Widening of the vertebral pedicles CT myelo may be necessary to identify extradural tumors

66. Treatment of Spinal Tumors Both intramedullary and extramedullary can be removed surgically 50% of patients who have surgery experience a reverse of clinical anomalies In cases where surgery is contraindicated Radiation therapy is the primary means of treating a tumor

67. Brain Tumors Gliomas acct for 50% of all brain tumors Meningiomas are the most frequently occurring nonglial tumors All tumors have greater incidence in males Interfere with circulation of the CSF causing a hydrocephalus Gliomas acct for 50% of all brain tumors Types of gliomas include: Astrocytoma & ependymoma Ependymomas predominate in 3-4 yr olds Meningiomas are the most frequently occurring nonglial tumors Primarily affecting adults around 50 yrs old They are non-aggressive All tumors have greater incidence in males Interfere with circulation of the CSF causing a hydrocephalus Gliomas acct for 50% of all brain tumors Types of gliomas include: Astrocytoma & ependymoma Ependymomas predominate in 3-4 yr olds Meningiomas are the most frequently occurring nonglial tumors Primarily affecting adults around 50 yrs old They are non-aggressive All tumors have greater incidence in males Interfere with circulation of the CSF causing a hydrocephalus

68. Brain Tumors In children 20% of all tumors are brain tumors Most common are astrocytomas, medulloblastomas, glioblastomas and craniopharyngliomas 30% of primary ped. tumors are medulloblastoma In adults most prevalent are: Astrocytomas, glioblastomas, metastatic tumors and menigiomas

69. Astrocytomas of Brain

70. Ependymoma of Brain

71. Medulloblastomas of Brain

72. Craniopharyngliomas of Brain

73. Metastatic Tumor of Brain

74. Meningiomas of Brain

75. Symptoms of Brain Tumors Headache Nausea and Vomiting Lethargy Seizures Paralysis Aphasia Blindness Deafness Abnormal changes in personality & behavior

76. Treatment of Brain Tumors Surgical resection Radiation therapy Survival rate for surgery & Radiation therapy combined is 80% over a 5 year period Rate of survival decrease to 3% over a 10 year period

77. Hydrocephalus Can be congenital or acquired Refers to an excessive amount of fluid in the ventricles Two types Non- communicating Communicating Can be congenital or acquired Refers to an excessive amount of fluid in the ventricles Two types Non- communicating Interferes or blocks normal CSF circulation from the ventricles to the subarachnoid space Communicating Poor absorption of the CSF by the arachnoid Villi Least common cause is from overproduction of CSF Can be congenital or acquired Refers to an excessive amount of fluid in the ventricles Two types Non- communicating Interferes or blocks normal CSF circulation from the ventricles to the subarachnoid space Communicating Poor absorption of the CSF by the arachnoid Villi Least common cause is from overproduction of CSF

78. Hydrocephalus Non-communicating Can be congenital Can be from tumor growth Trauma (hemorrhage) Inflammation Communicating Can come with increased cranial pressure Raised intrathoracic pressure impairing venous flow Inflammation from meningitis Subarachnoid hemorrhage

79. Radiographic Appearance Generalized enlargement of the ventricular system PA radiograph can reveal separation of the sutures CT clearly demonstrates ventricular dilatation MRI is more specific in demonstrating the underlying cause of obstruction or in excluding obstruction Ultrasound is useful in utero and in infants Sound waves transverse open fontanels PA radiograph can reveal separation of the sutures and widening of the fontanelles. PA radiograph can reveal separation of the sutures and widening of the fontanelles.

80. Hydrocephalus

81. Hydrocephalus

82. Hydrocephalus Clinical Symptoms The cranial size is enlarged Scalp veins distended Skin of scalp thin, fragile and shiny Neck muscles underdeveloped Severe cases Orbital roofs are depressed Eyes displaced downwards

83. Treatment of Hydrocephalus Placement of a shunt Internal jugular, heart or peritoneum Contains one way valve to prevent backflow of blood into ventricles Radiographs taken to verify shunt placement CT or MRI done to evaluate success of treatment May consist of surgery in which a shunt can be inserted to divert excess fluids. May consist of surgery in which a shunt can be inserted to divert excess fluids.

84. Hydrocephalus in Infants Affects 1 of every 1000 newborns Long maturation of CNS Can be caused by maternal & fetal infections, fetal hypoxia, irradiation, chemical agents and mechanical forces Due to the long maturation period of the CNS, this gives way to many agents that can cause this illness.Due to the long maturation period of the CNS, this gives way to many agents that can cause this illness.

85. Hydrocephalus In Utero X-ray used to be taken for fetal age and position With hydrocephalic fetus- hard to deliver vaginally Pelvimetry was ordered to determine measurements of inlet and outlet Very uncomfortable Three exposures Pelvimetry was ordered to determine if the measurements of inlet and outlet allowed her to give birth vaginally. This was very uncomfortable for woman in labor to be positioned and remain still. 3 exposures were done that caused excessive radiation to fetus.Pelvimetry was ordered to determine if the measurements of inlet and outlet allowed her to give birth vaginally. This was very uncomfortable for woman in labor to be positioned and remain still. 3 exposures were done that caused excessive radiation to fetus.

86. Fetal Hydrocephalus Communicating The flow of CSF is free between ventricles & subarachnoid space about cauda equina Infants head is normal size but there is bulging of the frontal fontanelles Caused by poor absorption of CSF Non-communicating Obstruction between ventricles and cauda equina Most common form of obstructive hydrocephalus is from abnormalities between the 3rd and 4th ventricles

87. Multiple Sclerosis Chronic progressive disease of the nervous system Affects women more than men at approx 20-40 years of age There is no cure and it s origin is unknown Treatment only slows the process Some research indicates it may come from herpes or retrovirus Appears more in temperate climants than tropical climates

88. Multiple Sclerosis Demyelination of the myelin sheath covering nervous tissue of spinal cord & white matter within the brain It has episodes of relapses and remission Eventually leads to neurological damage Impairment of nerve conduction Patients life is not shortened Quality of life is diminished

89. Symptoms Of Multiple Sclerosis Difficulty speaking clearly Bladder dysfunction Muscle impairment Loss of balance Poor coordination Tremors Muscle weakness Double vision Nystagmus (rapid eye movement)

91. Imaging of Multiple Sclerosis Scars from areas of demyelinated nerves Sclerotic lesions throughout nervous system Called MS plaques MRI is modality of choice Contrast enhanced can differentiate active inflammation from older brain plaques Functional MRI assesses alterations in normal CSF function

92. Multiple Sclerosis: MRI

93. CT imaging of Multiple Sclerosis CT shows old inactive disease Well defined areas of decreased attenuation With contrast, in an acute phase Shows a mixture of decreased density (old) Enhancing regions (active)

94. Treatment for MS Immunosuppressive agents Limit the autoimmune attack Antiviral Slows the progress of the disease Beta interferon Immunomodulatory agents that reduce the severity of the attacks Given subcutaneously Corticosteroids (short term) Shortens the symptomatic periods Delays progression of disease Reduces frequency of attacks Regular exercise Reduces spasms and increases ROM

95. Cerebrovascular Accident (CVA) Is an atherosclerotic disease affecting blood supply to the brain 3rd leading cause of death in U.S. 2 types of stroke: Ischemic and Hemorrhagic Both CT and MRI distinguish between the two types MRI is especially sensitive to infarction within hours of onset CT, at times appears negative for a day or so Carotid duplex and MRA are also useful in the diagnosis of a stroke

96. Ischemic Stroke Blood clot blocks a blood vessel in the brain Is the majority of strokes Two types: Thrombosis of cerebral artery Blood clot that blocks a blood vessel Embolism of the brain Is a mass of undissolved matter (solid, liquid or gas) present in a blood vessel brought there by blood current Diagnosed with CT and MRI Angiography can be used if other modalities are questionable

97. Symptoms of Thrombotic Ischemic Stroke Symptoms come on over hours to days Confusion Hemiplegia Aphasia May be preceded by a temporary episode of nerurologic dysfunction called transient Ischemic attack (TIA) Includes hemiparesis, monocular blindness- clears up in about 2 hours PTs with thrombotic stroke are usually pt?s with coronary heart disease, heart attack is a frequent cause of death for those who have a thrombotic stroke. PTs with thrombotic stroke are usually pt?s with coronary heart disease, heart attack is a frequent cause of death for those who have a thrombotic stroke.

98. Ischemic Stroke: from Embolism Sudden onset of symptoms without warning Mortality rate is 20% Prognosis depends on location, extent, age, and general health Complete recovery is rare Deficits remaining after 6 months are likely to be permanent Treatment Bed rest Clot blockers within 3 hours (recombinant tissue plasminogen activator (rtPA)

99. Ischemic Stroke

100. Imaging of Ischemic Stroke Non-contrast CT scans are most commonly used MRI is also excellent for imaging CT, MRA and US may offer info regarding patency in the brain and carotid arteries PET may be used in the future to identify decreased Oxygen flow and consumption within the brain Non-contrast CT scans are most commonly used Before treatment with thrombolytic agents Best success if within 45 minutes of stroke Follow up CT or transcranial US used after meds to monitor success or meds MRI is also excellent for imaging In some cases more accurate than CT in identifying EARLY infarct signs CT, MRA and US may offer info regarding patency in the brain and carotid arteries PET may be used in the future to identify decreased Oxygen flow and consumption within the brain Shows promise but not currently used frequently Non-contrast CT scans are most commonly used Before treatment with thrombolytic agents Best success if within 45 minutes of stroke Follow up CT or transcranial US used after meds to monitor success or meds MRI is also excellent for imaging In some cases more accurate than CT in identifying EARLY infarct signs CT, MRA and US may offer info regarding patency in the brain and carotid arteries PET may be used in the future to identify decreased Oxygen flow and consumption within the brain Shows promise but not currently used frequently

101. Hemorrhagic Stroke Occurs from a weakening in the diseased blood vessel Typically weakened from atherosclerosis from hypertension Sudden and often lethal because it comes on so suddenly Accounts for 10-15% of all CVA?s Two types: Subarachnoid and Intracerebral

102. Hemorrhagic Stroke Most occur in the cerebrum and bleed into lateral ventricle Most often preceded by an intense headache and vomiting LOC follows in minutes and leads to contralateral hemiplegia or death Prognosis is poor 35% die day after stroke 15% die within a few weeks, usually from another vessel rupture

103. Imaging of Hemorrhagic Strokes CT is modality of choice Can demonstrate high density blood in the subarachnoid space in more than 95% of cases Can demonstrate aneurysms greater than 3mm With contrast is contraindicated because surgeon will not operate without an angiogram MRI is relatively insensitive for subarachnoid bleeds

104. Treatment of Hemorrhagic Strokes Surgery Preceded by a surgical angiogram If surgical intervention is postponed so will the angiogram

105. Hemorrhagic Stroke

106. Pathology Summary and Modality of Choice Pathology Summary: Central Nervous System Pathology Imaging Modalities of Choice Additive or Subtractive Pathology Hydrocephalus CT, MRI, sonography in the neonate Meningitis MRI Encephalitis MRI Brain abscess CT, MRI Herniated nucleus pulposus MRI, CT, myelography Cervical spondylosis Radiography Subtractive Multiple sclerosis MRI CVA MRI, CT, sonography, PET Glioma MRI, CT Medulloblastoma MRI, CT Meningioma CT, MRI Pituitary adenoma CT, MRI Craniopharyngioma CT Acoustic neuroma MRI Spinal tumor MRI, radiography, CT, myelography Both Metastases from other sites MRI, radiography, CTSubtractive


Other Related Presentations

Copyright © 2014 SlideServe. All rights reserved | Powered By DigitalOfficePro