CNS Emergency Flashcards
CT is best in :
Bone fractures
Acute stroke
Cerebral hemorrhage
CT head
Indications :
Obvious compound or depressed fractures
Suspected fracture of skull :scalp laceration or boggy scalp hematoma
Penetrating head injury
Signs of fractured base of skull :black eyes or nose bleeding with CSF discharge
Suspected intracranial foreign body
Scalp hematoma two types :
Cephalo hematoma : beneath the periosteum “ do not cross sutures
SubGaleal hematoma : between periosteum & galea aponeuritica
Types of hematoma in CT scan according to chronicity :
Acute hyper dense lesion
Subacute 7-10 day Isodense lesions
Chronic “more than 2 weeks” : hypodense
Describe the extradural hematoma :
Extra axial hyperdense lens shaped lesion on the RT side for example
“ must mention midline shift if there is one “
Acute on chronic subdural hematoma you can see : “ sign”
Fluid fluid sign
Description : extra axial crescent shaped lesion with mixed densities on the left side for example , with no midline shifting.
Differential diagnosis of cerebellopontine angle tumors:
AMEN
A coustic neuroma
M eningioma
E pendymoma
N euroepithelial cyst
Describe the Subarachnoid hemorrhage :
CT
Commonly caused by :
Hyperdense material occupying sulci & area surrounding the circle of Willis
Rupture of berry aneurysm
Intraventricular hemorrhage : the present of blood within the ventricular system
Can lead to :
Obstructive hydrocephalus
Describe intraventricular hemorrhage:
Hyperdense material occupying ventricles , heavier than CSF , pooling dependently in the occipital horn
Small amount of intraventricular hemorrhage can be detected by :
MRI is more sensitive than CT
MRI T2 Flair
Criteria of polycystic Kidney disease “ Ultrasound” :
Multiple anechoic non communicating cysts
Posterior acoustic enhancement
Infected or hemorrhagic cysts shows echogenic material
+/- Calcification
DDX of Ring enhanced lesion in the Brain :
Tumour : Glioblastoma , Metastasis
Abscess
Neurocysticercosis
Radiological features of Osteomylitis :
Acute :Intraosscieous abscess
Cloaca “beneath periosteum”
Subacute : Brodie’s abscess
Chronic Osteomylitis :
Séquestrum & involocrum
Radiological features of urinary TB :
Calyces become irregular
Cortical abscess
Fibrosis & ureteric stricture
Parenchymal calcifcation & auto nephrectomy
Urinary bladder fibrosis & irregularity
Main indication of IVU :
Investigation of kidney stone “ after KUB ; Detect site of stone & any kidney Cpx “
Investigation of Hematuria “ tumour give you filling defects”
Characterization of renal mass
Staging & follow up of renal mass
To diagnose renal trauma
USS is the best in renal ; what’s the uses of USS ?
Investigation patient with symptoms
Demonstrate the size of the kidney ”9-12 cm”
Diagnosis of Hydronephrosis , renal tumour , abscess
Assessment & follow up
Common causes of ileum stricture :
Crohn’s disease
TB
Lymphoma
Causes of narrowing lumen “ GIT “
Carcinoma
Diverticular disease
Crohn’s disease
Ischemia colitis
Causes of unilateral Hilar lymphadenopathy :
Malignant lymphoma
Infection particularly TB / histoplasmosis
Metastasis from Carcinoma of bronchus
Bilateral hilar lymphadenopathy causes :
Sarcoidosis “most common “
Malignant lymphoma
Fungal infection
Causes of urinary tract obstruction :
Calculus
Blood clot
Sloughed papillae
TB
Infective stricture
Medullary nephrocalcinosis causes :
Hyperparathyroidism
TB
Sarcoidosis
Medullary sponge kidney “ congenital anomaly ; small cyst ; urine stasis ; chronic inflammation
Grades of Renal injury :
Grade 1
minor injury ( contusion , laceration or subcapsular hematoma ; small perinephric hematoma “
Grade2
Major injury ( cortical laceration extend to medulla & collecting system with or without renal extravasation )
Grade3
Catastrophic injury ( multiple renal lacerations plus renal vascular injury )
Grade4
Uretropelvic junction injury with complete transection.
Contrast is contraindicated in :
Heart failure
Renal failure
“ can’t get rid off contrast “
Allergy to contrast
Patient with renal artery stenosis & contrast is contraindicated we use :
Can’t use CT Urogram
MRA
Magnetic resonance angiogram” see Aorta with all its branches”
Kidney in pelvis
Differential diagnosis :
Ectopic kidney
Kidney Transplantation
Best modality used in pelvis :
MRI “ eg : bladder tumour “
( MRI best in tumours)
Figure A is a T2-weighted MRI spine showing hyperintensity of the posterior region in the cervical spinal cord (green arrows).
Dx :
Subacute combined degeneration
