Brain CT Flashcards
a. Hyperdense lesion affecting the right thalamus
b. Hyperdense lesion affecting the right putamen
c. Hyperdense lesion affecting bilateral lateral ventricles
d. Right-sided convex hyperdense lesion
a. Acute subdural haematoma with ventricular extension
b. Intracerebral haemorrhage with ventricular extension
c. Subarachnoid haemorrhage
d. Intracerebral tumor with ventricular metastasis
b. Intracerebral haemorrhage with ventricular extension
Hemorrhages within the ventricles commonly occur as an extension from an underlying intracerebrasl hemorrhage (espeically those involving the thalamus and basal ganglia). They can also occur in isolation (as a result of underlying hypertensive angiopathy), or due to vascular lesions (e.g. cerebral aneurysms, AVM, moyamoya disease), coagulopathies and intraventricular tumors.
c. incorrect
a. Cerebral amyloid angiopathy
b. Hypertension
c. Saccular aneurysm
d. Head injury
b. Hypertension is the most common cause of cerebral small vessel disease and can lead to hypertensive angiopathy. A small number of pathological cahnges occur in the blood vessels including lipohyalinosis, arteriosclerosis and microaneurysm formation. These changes in the blood vessels make them more vulnerable to occlusion, resulting in lacunar infarcts; but also to rupture, resulting in intracerebral hemorrhages. Intracerebral hemorrhages secondary to hypertension are usually deep seated, involving structures such as the thalamus, internal capsule, basal ganglia, brainstem, cerebellum.
c. incorrect as saccular aneurysms are most common cause of spontaneous subarachnoid hemorrhage
d. incorrect –> head injury can lead to a variety of intracranial hemorrhages, including epidural haematomas, subdural haematomas, subarachnoid hemorrhages and hemorrhagic contusions. Hemorrhagic contusions typically involve the inferior frontal and anterior temporal lobes.
a. Blood pressure control
b. Carotid endarterectomy
c. Anticoagulation
d. Craniotomy
A. correct. BP is reaised in 70% of patients presenting with stroke. In patients with acute intracerebral hemorrhage, acute lowering of systolic BP to a targeet of 140mmHg with the goal of maintaining in the range of 130-150mmHg is recommended.
b. incorrect. Carotid endarterectomy is considered in patients with severe carotid stenosis presenting with a TIA or ischemic stroke
c. Incorrect. Anticoagulants for TIA or ischemic stroke due to cardioembolic cause (e.g. AF or in patients with underlying mechanical heart valve) and will not usually be prescribed in patients with an intracerebral hemorrhage, especially when already bleeding.
d. Incorrect. Most patients with supratentorial intracerebral hemorrhage do not require surgical treatment. In selected patients with a supratentorial intracerebral hemorrhage who are deteriorating, craniotomy for haematoma evacuation may be considered as a lifesaving measure. Patients with large cerebellar intracerebral hemorrhage who are deteriorating neurologically, have evidence of brain compression, and/or hydrocephalus from ventricular obstruction, immediate surgical removal of hemorrhage is recommended in preference to medical Mx alone to reduce mortality
What is seen?
Right sided convex (lens shaped) hyperdense lesion with midline shift
dx?
non contrast CT scan of intracerebral hemorrhage with ventricular extension
dx?
Subarachnoid hemorrhage: high density material that fills the subarachnoid space as shown in non contrast CT scan
dx?
Acute subdural haematoma
dx?
Acute epidural haematoma
This characteristic shape arises as the periosteal dura, which is tightly adherent to the inner skull, is stripped away from the inner skull. Also, as the dura is tightly attached to sutures, epidural haematomas rarely cross suture lines. In contrast, subdural haematomas can freely cross suture lines.
Can tumor cause epidural bleed?
Intracranial malignancy (primary or secondary) may be complicated with bleeding (hemorrhagic intracranial tumors or tumor bleed), it does not occur in the epidural space
Hypodensity affecting the right middle cerebral artery territory
dx?
hypodensities affecting the anterior cerebral artery territory bilaterally
dx?
non-contrast CT scan shows hypodensity affecting the left posterior cerebral artery territory
dx?
non-contrast CT scan shows hypodensity affecting the cortical watershed zones bilaterally. These watershed areas are where the terminal vasculature of the anterior cerebral artery and middle cerebral artery meet, as well as where the middle cerebral artery and posterior cerebral artery meet.
dx?
Chronic infarct. The left ventricle is dialted (ex vacuo dilatation: open arrow) because there is volume loss of the surrounding brain parenychma, and the ventricle expands into this space. Look for volume loss of brain and ex cavuo dilatation of ventricles to help distinguish chronic from acute/subacute infarcts.