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CNS Pathology






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CNS Pathology. Fall 2009 Final. INFLAMMATORY DISEASE OF CNS. 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
CNS Pathology

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Cns pathology l.jpgSlide 1

CNS Pathology

Fall 2009

Final

Inflammatory disease of cns l.jpgSlide 2

INFLAMMATORY DISEASE OF CNS

Meningitis l.jpgSlide 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)

Pathogens causing meningitis l.jpgSlide 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

Pathogens causing meningitis5 l.jpgSlide 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

Acute meningitis clinical symptoms l.jpgSlide 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

Diagnosis of meningitis l.jpgSlide 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

Radiographic appearance l.jpgSlide 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

Meningitis as a result of a Staph infection

Encephalitis l.jpgSlide 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

Encephalitis10 l.jpgSlide 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

Encephalitis symptoms and treatment l.jpgSlide 11

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

Encephalitis:Symptoms and Treatment

Congenital diseases of cns l.jpgSlide 12

CONGENITAL DISEASES OF CNS

Spinal bifida l.jpgSlide 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

Types of spinal bifida l.jpgSlide 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

Types of spinal bifida15 l.jpgSlide 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

Radiographic appearance16 l.jpgSlide 16

Radiographic Appearance

Meningomyelocele

  • Can be demonstrated with CT, MRI and myelography

    • Prenatally with ultrasound (in utero)

  • Large bony defects

  • Herniated spinal contents

Meningocele

Meningomyelocele l.jpgSlide 17

Meningomyelocele

  • Most serious

  • Affected PT’s have severe neurologic deficits

    • Paraplegia

    • Diminished control of lower limbs, bladder and bowels

    • Hydrocephalus is common

Spinal bifida imaging l.jpgSlide 18

Spinal Bifida Imaging

Spinal bifida treatment l.jpgSlide 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

Cranial and spinal fractures l.jpgSlide 20

CRANIAL AND SPINAL FRACTURES

Cranial fractures l.jpgSlide 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

Cranial fractures22 l.jpgSlide 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

Cranial fractures23 l.jpgSlide 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

Linear fractures l.jpgSlide 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

Linear skull fx l.jpgSlide 25

Linear Skull FX

Depressed fracture l.jpgSlide 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

Depressed skull fx l.jpgSlide 27

Depressed Skull FX

Basilar fracture l.jpgSlide 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

Compression fracture of spine l.jpgSlide 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

Compression fx of spine l.jpgSlide 30

Compression FX of Spine

Compression fx of spine31 l.jpgSlide 31

Compression FX of Spine

Hangman s fracture l.jpgSlide 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

Hangman s fracture33 l.jpgSlide 33

Hangman’s Fracture

Hangman s fracture34 l.jpgSlide 34

Hangman’s Fracture

Jefferson s fracture l.jpgSlide 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

Jefferson s fracture36 l.jpgSlide 36

Jefferson’s Fracture

Jefferson s fracture37 l.jpgSlide 37

Jefferson’s Fracture

Traumatic disease l.jpgSlide 38

TRAUMATIC DISEASE

Cerebral contusion l.jpgSlide 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

Ct appearance of cerebral contusion l.jpgSlide 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

Mr of cerebral contusion l.jpgSlide 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

Cerebral contusion42 l.jpgSlide 42

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

Cerebral Contusion

Cerebral contusion43 l.jpgSlide 43

Cerebral Contusion

Hematomas l.jpgSlide 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

Epidural hematomas l.jpgSlide 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

Epidural hematoma l.jpgSlide 46

Epidural Hematoma

Usually a shift of midline

Toward opposite side

CT shows increased

density

Emergency surgical

decompression is required to relieve cranial pressure

Subdural hematomas l.jpgSlide 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)

Subdural hematoma l.jpgSlide 48

Subdural Hematoma

Occurs more slowly

Because it is a venous

Hemorrhage.

On CT appears as a

curvilinear area of I

increased density on

portions or all of the

cerebral hemispheres

Subdural hematomas49 l.jpgSlide 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

Symptoms of hematomas l.jpgSlide 50

Symptoms of Hematomas

  • Headaches

  • Agitation

  • Drowsiness

  • Gradual radiograph deficits

Treatment of hematomas l.jpgSlide 51

Treatment of Hematomas

  • In small hematomas without inclination to rebleed

  • Severe cases

  • Less invasive treatment may include

Degenerative diseases l.jpgSlide 52

Degenerative Diseases

Herniated disk l.jpgSlide 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

Herniated disk54 l.jpgSlide 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

Herniated disk55 l.jpgSlide 55

Herniated Disk

Herniated disk56 l.jpgSlide 56

Herniated Disk

  • MRI is modality of choice

    • CT and Myelography can also be used

Symptoms of herniated disk l.jpgSlide 57

Symptoms of Herniated Disk

  • Sudden weak & severe onset of pain

  • Compression of nerve roots in C-spine:

  • Compression in lumbar in L-spine:

Treatment herniated disk l.jpgSlide 58

Treatment: Herniated Disk

  • Conservative treatment

  • Surgical intervention

Herniated disk fusion l.jpgSlide 59

Herniated Disk: Fusion

Brain spinal tumors l.jpgSlide 60

Brain & Spinal Tumors

Spinal tumors l.jpgSlide 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

Symptoms of spinal tumors l.jpgSlide 62

Extramedullary

Similar symptoms as a herniated nucleus pulposus

Compress nerve roots leading to pain and muscle weakness

Intramedullary

Can cause progressive paraparesis

Sensory loss

Symptoms of Spinal Tumors

Extramedullary spinal tumors l.jpgSlide 63

Extramedullary Spinal Tumors

Meningioma

Neurofibroma

Intramedullary spinal tumors l.jpgSlide 64

Intramedullary Spinal tumors

Astrocytoma

Ependymoma

Imaging of spinal tumors l.jpgSlide 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

Treatment of spinal tumors l.jpgSlide 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

Brain tumors l.jpgSlide 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

Brain tumors68 l.jpgSlide 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

Astrocytomas of brain l.jpgSlide 69

Astrocytomas of Brain

Usually treated

with surgery and

radiation therapy

Have good 5 year survival rate

Ependymoma of brain l.jpgSlide 70

Ependymoma of Brain

Usually treated with surgical removal

Medulloblastomas of brain l.jpgSlide 71

Medulloblastomas of Brain

Craniopharyngliomas of brain l.jpgSlide 72

Craniopharyngliomas of Brain

Metastatic tumor of brain l.jpgSlide 73

Metastatic Tumor of Brain

Meningiomas of brain l.jpgSlide 74

Meningiomas of Brain

Usually benign

More frequent in women

Rare in children

Less common to see

in brain than spinal cord

Symptoms of brain tumors l.jpgSlide 75

Symptoms of Brain Tumors

  • Headache

  • Nausea and Vomiting

  • Lethargy

  • Seizures

  • Paralysis

  • Aphasia

  • Blindness

  • Deafness

  • Abnormal changes in personality & behavior

Treatment of brain tumors l.jpgSlide 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

Hydrocephalus l.jpgSlide 77

Hydrocephalus

  • Can be congenital or acquired

  • Refers to an excessive amount of fluid in the ventricles

  • Two types

    • Non- communicating

    • Communicating

Hydrocephalus78 l.jpgSlide 78

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

Hydrocephalus

Radiographic appearance79 l.jpgSlide 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

Hydrocephalus80 l.jpgSlide 80

Hydrocephalus

Hydrocephalus81 l.jpgSlide 81

Hydrocephalus

Hydrocephalus clinical symptoms l.jpgSlide 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

  • In adults

    • ALOC

    • Ataxia

    • Incontinence

    • Decreased intellectual

    • capabilities

Treatment of hydrocephalus l.jpgSlide 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

Ventricularjugular Shunt

Hydrocephalus in infants l.jpgSlide 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

Hydrocephalus in utero l.jpgSlide 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

Fetal hydrocephalus l.jpgSlide 86

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

Fetal Hydrocephalus

Multiple sclerosis l.jpgSlide 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

Multiple sclerosis88 l.jpgSlide 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

Symptoms of multiple sclerosis l.jpgSlide 89

Difficulty speaking clearly

Bladder dysfunction

Muscle impairment

Loss of balance

Poor coordination

Tremors

Muscle weakness

Double vision

Nystagmus (rapid eye movement)

Symptoms Of Multiple Sclerosis

Slide90 l.jpgSlide 90

HALLMARKS OF MS :

SPINAL

CORD

BRAIN

DEMYELINATION AREAS

Imaging of multiple sclerosis l.jpgSlide 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

Multiple sclerosis mri l.jpgSlide 92

Multiple Sclerosis: MRI

Ct imaging of multiple sclerosis l.jpgSlide 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)

Treatment for ms l.jpgSlide 94

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

Treatment for MS

Cerebrovascular accident cva l.jpgSlide 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

Ischemic stroke l.jpgSlide 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

Symptoms of thrombotic ischemic stroke l.jpgSlide 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

Ischemic stroke from embolism l.jpgSlide 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)

Ischemic stroke99 l.jpgSlide 99

Ischemic Stroke

Imaging of ischemic stroke l.jpgSlide 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

Hemorrhagic stroke l.jpgSlide 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

Hemorrhagic stroke102 l.jpgSlide 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

Imaging of hemorrhagic strokes l.jpgSlide 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

Treatment of hemorrhagic strokes l.jpgSlide 104

Treatment ofHemorrhagic Strokes

  • Surgery

    • Preceded by a surgical angiogram

  • If surgical intervention is postponed so will the angiogram

Hemorrhagic stroke105 l.jpgSlide 105

Hemorrhagic Stroke

Pathology summary and modality of choice l.jpgSlide 106

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

Pathology Summary and Modality of Choice


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