Brain Flashcards
what do you call the gyri in the cerebellum
folia
what imaging modality is best for seeing pathology
T2
what is impacted in a posterior circulation stroke
occipital lobes
vision problems, vertigo
what determines the neurological defect a patient presents with in stroke
anatomical site of injury to brain parenchyma
what do you need to confirm the absence of to start thrombolysis/thromboectomy
haemorrhage (do unenhanced CT to look for blood) stroke mimic (tumour, seizure etc)
what is the PCA territory
occipital lobes
what is MCA territory
outside of brain
what is ACA territory
inside of brain up to frontal lobes
earliest visible CT sign for ismchaemic stroke
hyperdense segment of a vessel
wishing first few hours what does ismchaemic stroke look like on CT
loss of grey-white matter differentiation
hypo attenuation of deep nuclei (happens in insular cortex first?)
cortical hypo density with associated parenchymal swelling with resultant gyral enhancement
what does advanced stroke look like on CT
hypo attenuation and swelling become more marked resulting in significant mass effect
what does advanced ismchaemic stroke look like on CT
hypo attenuation and swelling become more marked resulting in significant mass effect
what does an old ischaemic stroke look like on CT
more gloss occurs eventually appearing as region of low density with volume loss
what does acute blood appear as on unenhanced CT
white
causes of intracranial haemorrhage
trauma
underlying lesion
what is intra axial haemorrhage
within the brain substance
example of axial haemorrhage
lobar haemorrhage
midline shift
acute haematoma in basal ganglia (type of haemorrhage stroke)
what is extra-axial haemorrhage
out with the brain substance
eg. in the meninges
what is extradural haemorrhage
between the skull and the outer layer of dura
usually associated with trauma
bleeding usually arterial most common from torn middle meningeal
classically overlies the temporal parietal region
mass effect causing midline shift
what is a subdural haemorrhage
blood between dura and arachnoid matter
normally in elderly patients due to tearing of bridging veins as brain shrinks away from dura with age
also seen in shaken baby syndrome
needs CT
semilunar shape
crosses structures
mass effect
subdural will NOT cross the midline
if you can’t see sulci going all the way out to the edge its a sign of subdural haematoma (chronic)
moon shaped
what does an acute on chronic subdural haematoma look like
chronic clotted blood goes to back, new acute blood goes to front
what is subarachnoid haemorrhage
blood within the subarachnoid space
hyper dense material found filling the subarachnoid space
commonly around the circle of willis
can be traumatic or located to other vascular formations
WHITE STAR SIGN
see it in:
- suprasellar cistern
- others
do CT cerebral angiography to look for underlying berry aneurysm
what causes death in subarachnoid haemorrhage
hydrocephalus, vasospasm and infarction
early signs of hydrocephalus
enlarged temporal horns
most common causes of brain mets
lung breast melanoma small cell colorectal
first line test for brain mass
CT
can be hypo or hyper dense
solitary or multiple
useful to determine oedema/mass effect
if crossed BBB then will be enhanced?? less likely to if not??
hallmarks of metastatic disease
lots of oedema
lots of mass effect
avidly enhance
hallmarks of primary brain tumours
solitary
supra or infra tentorial
degree of oedema
mass effect and enhancement depends on grade
most common brain tumour
glioma
what is coning
basilar tonsils pushed out the bottom of the brain
what is the spinal cord contained in
thecal sac
what nerve root comes out the bottom of L3 for example:
L3
L4 comes out on top?
causes of spinal cord compression
disc vertebrae epidural space dura intradural space
treatment for cord compression
urgent MRI spine
how does cord compression present
back pain with red flags
- history of malignancy
- major trauma
- thoraci/radicular pain
- constant progressive non-mechanical pain
- systemically unwell
- widespread neurological signs and symptoms
loss of power in lower limbs
saddle anaesthesia, loss of sensation
treatment for cord compression
urgent MRI spine
treat cause?
