INTRACRANIAL HEMATOMAS and HEAD CT.

SCAN
anwar wardy w, DR dr SpS, DFM dept.neurologyct.scan

Presenters: Anwar Wardy W Dept. Neurology FK UMJ

anwar wardy w, DR dr SpS, DFM

dept.neurologyct.scan

Objective:
To explain how head and intracranial hematomas view on CT.SCAN

Cerebral Blood Supply

anwar wardy w, DR dr SpS, DFM dept.neurologyct.scan

Cerebral Blood Supply side view

anwar wardy w, DR dr SpS, DFM dept.neurologyct.scan

Middle Cerebral Artery

anwar wardy w, DR dr SpS, DFM dept.neurologyct.scan

http://www.strokecenter.org/education/ais_vessels/ais049b.html

Posterior Cerebral Circulation

anwar wardy w, DR dr SpS, DFM dept.neurologyct.scan

http://www.strokecenter.org/education/ais_vessels/ais049c.html

Circle of Willis
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Sits at the base of the brain Joins the anterior and posterior circulation Important route of secondary or collateral circulation Most common site for congenital aneurysm
http://www.strokecenter.org/education/ais_vessels/ais048.html

Location

anwar wardy w, DR dr SpS, DFM

dept.neurologyct.scan

http://www.nlm.nih.gov/medlineplus/ency/imagepages/18009.htm

anwar wardy w, DR dr SpS, DFM

dept.neurologyct.scan

http://www.meddean.luc.edu/lumen/meded/Neuro/neurovasc/navigation/cow.htm

anwar wardy w, DR dr SpS, DFM

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The Brain

Frontal Lobe

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Blood supply - ACA and MCA Major functions:

personality, behaviour motor function judgement/problem solving micturation expressive speech - Brocas word formation, articulation and speech production concentration, reasoning

Neuroanatomy and Cerebral Circulation Review, West GTA Stroke Network, 2003

Parietal Lobe
Blood supply ACA, MCA and PCA Major functions:
sensory function body part awareness visual spatial information

anwar wardy w, DR dr SpS, DFM

dept.neurologyct.scan

Neuroanatomy and Cerebral Circulation Review, West GTA Stroke Network, 2003

anwar wardy w, DR dr SpS, DFM

dept.neurologyct.scan

Temporal Lobe
Blood supply - MCA and PCA Major Functions:
understanding speech -Wernickes visual, olfactory and auditory perception learning, memory, emotional affect

Neuroanatomy and Cerebral Circulation Review, West GTA Stroke Network, 2003

anwar wardy w, DR dr SpS, DFM

dept.neurologyct.scan

Occipital Lobe
Blood supply - MCA,PCA Major Functions:
primary visual area some visual reflexes involuntary smooth eye movements recognition & identification of objects

Neuroanatomy and Cerebral Circulation Review, West GTA Stroke Network, 2003

anwar wardy w, DR dr SpS, DFM

dept.neurologyct.scan

Cerebellum
Blood supply Vertebrobasilar Major Functions:
control of fine motor movement coordinates muscle groups maintains balance, equilibrium

Neuroanatomy and Cerebral Circulation Review, West GTA Stroke Network, 2003

anwar wardy w, DR dr SpS, DFM

dept.neurologyct.scan

Brain Stem
Blood supply - PCA & Vertebrobasilar Major divisions - midbrain, pons, medulla Houses CN III-XII Serves as a pathway Reticular Activating System

Neuroanatomy and Cerebral Circulation Review, West GTA Stroke Network, 2003

Motor & Sensory Function

anwar wardy w, DR dr SpS, DFM dept.neurologyct.scan

Types of intracranial hematomas.

anwar wardy w, DR dr SpS, DFM dept.neurologyct.scan

The brain is covered by 3 membranes: the dura mater which is the outermost and lies just beneath the skull, the arachnoid mater which is the intermediate layer, the pia mater which is firmly adherent to the brain tissue.

anwar wardy w, DR dr SpS, DFM

dept.neurologyct.scan

Epidural hematoma

anwar wardy w, DR dr SpS, DFM

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Ischemic Stroke CT scan

anwar wardy w, DR dr SpS, DFM

dept.neurologyct.scan

Subdural hematoma

Subdural Hematoma

anwar wardy w, DR dr SpS, DFM

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Hemorrhagic Stroke CT scan

anwar wardy w, DR dr SpS, DFM

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3. Intracerebral hematomas. blood clots within the brain tissue.

can result from one or more contusions and this is followed by local oedema .
may increase in size, causing increased intracranial pressure and intracranial herniations of the brain. Symptoms depend on the area of the brain parenchyma affected.
Intracerebral Hematoma

Ischemic Penumbra
Area around infarct Infarcted brain tissue dies quickly - brain cells within the penumbra remain viable for several hours after stroke Penumbra cells supplied with blood by collateral arteries Reperfusion important as circulation becomes inadequate with time
dept.neurology-ct.scan anwar wardy w, DR dr SpS, DFM

Possible consequences of intracranial hemorrhages

anwar wardy w, DR dr SpS, DFM dept.neurologyct.scan

Raised pressure inside the skull, presents with headache, impaired consciousness, nausea and vomiting, papilloedema.

Intracranial shift or herniation

Posttraumatic epilepsy Posttraumatic hydrocephalus Psychiatric disorders Brain swelling

Note: For people taking anticoagulants e.g aspirin, the possibility of developing intracranial hematomas from minor head injuries is increased.

anwar wardy w, DR dr SpS, DFM

dept.neurologyct.scan

References:
R.Macsween,K.Whaley,Muirs text book of pathology,13th edition pages 814-817. Kumar,Abbas,Fausto,Aster,Robbins&Cotran pathologic basis of disease,8th edition,pages 1287-1290. http://www.merck.com/mmpe/sec21/ch310/ch310a.ht ml#sec21-ch310-ch310a-253 Microsoft student with Encarta encyclopedia 2008 (hematomas) http://www.merck.com/mmhe/sec06/ch087/ch087e.ht ml http://strokedoc.typepad.com/stroke_doc/2006/01/int racerebral_h.html