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Edema Increased water in brain parenchyma.. Types of Herniations 1.Subfalcine herniation (cingulate gyrus) 2.Transtentorial Herniation (uncal gyral) 3.Tonsillar.

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Presentation on theme: "Edema Increased water in brain parenchyma.. Types of Herniations 1.Subfalcine herniation (cingulate gyrus) 2.Transtentorial Herniation (uncal gyral) 3.Tonsillar."— Presentation transcript:

1 Edema Increased water in brain parenchyma.

2 Types of Herniations 1.Subfalcine herniation (cingulate gyrus) 2.Transtentorial Herniation (uncal gyral) 3.Tonsillar Herniation

3 Mass 1.Tumor 2.Blood clot 3.Abscess 4.Local edema S T

4 Transtentorial Herniation [involve Uncal gyral]

5 Transtentorial Herniation [Uncus]

6 Cerebral Herniation Complication of Intracranial Hypertension Tonsillar herniation Cerebellar tonsils herniate into the foramen magnum. Causes "coning" of the cerebellar tonsils Produces cardiorespiratory arrest Coma and Death 6

7 It can occur as an complication of Lumber Puncture

8 Complications of Tonsillar Herniation & Increased ICP Hemorrhagic lesion of the mid Brain and Pons : Secondary Brain stem or Duret hemorrhage Linear hemorrhage

9 Duret hemorrhage: pathogenesis Kinking of the penetrating median and paramedian pontine arteries that branch off the basilar artery.

10 Duret hemorrhage : causes 1. Tonsillar Herniation 2. Intracranial Neoplasm 3. Intracranial hemorrhage (basal ganglia )

11 Hydrocephalus Accumulation of excessive CSF within the ventricular system & enlargement

12 CT scan of Hydrocephalous

13 Overproduction of CSF (choroid plexus tumor)

14 Communicating Hydrocephalous. 1.Meningitis. 2.Subarachnoid hemorrhage Obstruction in subarachnoid space

15 Non communicating Hydrocephalous (Obstructive) 1.Medulloblastoma, 2.Ependymoma No communication between ventricles and subarachonoid space.

16 Congenital hydrocephalous (present at birth) Aqueductal stenosis (narrowing) is the most frequent cause. Blockage of fourth ventricle outlet (Dandy Walker Syndrome) – due to congenital malformation

17 The gross shows hydrocephalus of the frontal horns of the lateral ventricles.

18 Hydrocephalous before the fusion of the cranial Sutures [Head circumference increase]

19 Hydrocephalous after the fusion of the Sutures, produce Ventricular expansion and Increased Intracranial Pressure

20 Anencephaly 20

21 Types of spina bifida: A: Spina bifida occulta B: Meningocele C: Meningomyelocele 21 Spina bifida

22 Syringomyelia 22 Note the collapsed cystic cavity (syrinx) in the center of the cervical spinal cord

23 Brain contusion 23 The contrecoup injury involves the frontal and temporal lobes (left arrows) The coup lesion (site of impact) involves the cerebellum (right arrow).

24 Epidural and Subdural Hematoma 24

25 Red Neuron 25

26 Border zone infarct: Watershed infarct : Follows a Hypotensive episode. Lesion lies at the boundary between the anterior and middle cerebral artery territories.

27 Atherosclerotic (thrombotic) stroke 27

28 Amaurosis fugax 28

29 Embolic Stroke 29

30 Intracerebral Hemorrhage 30

31 Berry Aneurysms 31

32 Subarachnoid Hemorrhage 32

33 Lacunar Infarcts 33 The arrows show multiple small cystic spaces (liquefactive necrosis) that are most prominent in the basal ganglia.

34 Lacunar infarcts Cause : Chronic hypertension Site: The pons.

35 Pyogenic Meningitis

36 Microscopically, a neutrophilic exudate is seen involving the meninges

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39 Spongiform encephalopathy of gray matter : brain lesion in CJD

40 Complications: sequel 1.Edema can lead to herniation and death. 2.Communicating hydrocephalous.

41 Meningeal Syphilis 1 of 2 Neurosyphilis is a tertiary stage of syphilis – only in 10% with untreated syphilis May involve spinal Meninges: produce thickening. Produce meningeal fibrosis and secondary Hydrocephalous.

42 Neutrophils in the abscess.

43 Abscess in the brain in a patient who had septicemia.

44 Atrophy There is marked atrophy seen superiorly and laterally.

45 The cortical atrophy leads to compensatory dilation of the cerebral ventricles [hydrocephalus ex vacuo ]

46 Self Study For anatomy, not for exam

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