Brain bleeds and more brain pathologies Flashcards
What colour is CSF on CT
Black on CT
What does isointense mean?
Having the same intensity as another object. Used to describe the results of imaging tests, such as x-rays, MRIs, or CT scans.
What is the dura
The dura mater often gets referred to as merely the dura. It is one of the layers of connective tissue that make up the meninges of the brain (pia, arachnoid, and dura, from inside to outside). It is the outermost layer of the three meninges that surround and protect the brain and spinal cord
epidural hematoma
Usually happens with a skull fracture
The fractured bones lacerates a dural artery or venous sinus.
The blood from the vessel collects between the skull and the dura
Biconvex (Lemon) shaped
Almost always arterial
Usually cannot cross suture lines
Can cross falx cerebri
Does not cross into the cerebrum
Subarachnoid haemorrhage
Injury to small arteries
The vessel bleeds between the pia and arachnoid matter
(occurs due to trauma or aneurysm)
Can cross suture lines but not falx cerebri
Does not extend into the cerebrum
Patient often presents with thunderclap headache
Blood enters the subarachnoid space, most commonly around the circle of willis and sylvian fissure
Can be traumatic but often from ruptured aneurysm (~80%)
Blood contained to ‘gaps’ in the cerebrum
Subdural hematoma
Blood gathers with the outermost meninges layer
between the dura matter, which adheres to the skull
and the the arachnoid matter, which envelopes the brain
Blood pools between the dura mater and arachnoid mater
Mostly traumatic, but can rarely be spontaneous
Primarily Venous
Usually convex/crescent moon shaped
Can cross suture lines but not falx cerebri
Does not extend into the cerebrum
Haemorrhagic stroke
Due to rupture of blood vessel
hydrocephalus
A problem with the production of CSF to its re-absorption (more often in children)
congenital hydrocephalus – hydrocephalus that’s present at birth
acquired hydrocephalus – hydrocephalus that develops after birth (injury or illness e.g brain tumour)
normal pressure hydrocephalus – usually only develops in older people
Intracranial tumour symptoms
Generally present with a focal neurological deficit, seizure or headache
Meningioma
A meningioma is a primary central nervous system (CNS) tumor
Sometimes the tumour will calcify (appear white on CT)
Usually they are isointense to gray matter
Often slow growing tumour in the meninges
~30% of brain tumours (Starr & Cha, 2017)
What are the 2 main categories of acute stroke?
Ischaemic (A blockage leading to reduced blood supply to an area)
Haemorrhagic (bleeding)
What are the type types of Ischaemic stroke
Thrombosis – clot has formed within the vessels of the brain
Embolic – clot has formed elsewhere in the body – normally in the heart or carotid vessels – and travels to the brain where it forms a clot in a blood vessel. This can happen during angiography procedures.
Another name for epidural
Extradural
What is mass effect
Shift of the brain to one side due to presence of mass/fluid
Use the falx cerebri to determine the midline position and assess deviation
Intracerebral/Intraparenchymal haemorrhage
Causes
Location
Prognosis
Usually non traumatic, due to aneurysm/AV malformation rupture. More common in anticoagulated patients
Can also be associated with stroke
Blood seen within the brain tissue itself
Often causes mass effect
Within the brain so not contained by meninges
Very poor prognosis
Empyema meaning
Infective collection between dura and arachnoid mater
Can mimic subdural haemorrhage
Treatment for brain bleeds
Essential to monitor Intercranial pressure (ICP), Normal ICP 7-15mmHg (Steiner & Andrews, 2006)
ICP Bolt Device inserted through skull to monitor ICP in real time
Surgical evacuation of blood
Craniectomy (removal of part of skull to release pressure
Acute Meningitis
Acute inflammation of the meningeal coverings of the brain
Can be caused by viruses, bacteria and other microorganisms, and certain drugs
Life-threatening condition
Arteriovenous Malformation (AVM)
Essentially a ‘tangle’ of arteries & veins
Can be very painful and even rupture
Common in the brain but can occur anywhere in the body
Usually treated by embolisation (Injection of coil/glue to block off blood supply)
Cerebral Aneurysm
Can also be very painful and rupture
Life threatening if ruptures
Can be treated by surgical clipping
Also treated with coiling/embolization in Interventional Radiology
hydrocephalus treatment
Insertion of a shunt
Excess CSF diverted away from the head to another place in the body where it can be removed naturally by the body.
Different types of shunt
Ventriculo-atrial (VA) – removes CSF from ventricle and takes to a vein either in neck or clavicular region
Ventro-peritoneal (VP) – removes CSF from ventricle and sends it to the peritoneal space.
External Ventricular Drainage (EVD)- drains CSF externally into a drainage bag
What is Multiple Sclerosis- MS?
What is the appearance on MRI?
Autoimmune condition (body attacks itself)
Immune system attacks myelin sheath around nerves
This causes disruption to nerve signals
‘Plaques’ visible on MRI, hyperintense on most sequences
Brain Tumour most common type and common subtypes
Most common type- Glioma
Common subtypes;
Astrocytoma
Glioblastoma
