1. Med Students Lecture Series NEURO
University Hospitals Case Medical Center
Department of Radiology

2. Normal Brain Anatomy

3. Normal Brain Anatomy

4. Normal Brain Anatomy 1 – chiasma 2 – brainstem 3 – frontal sinus
1 – chiasma
2 – brainstem
3 – frontal sinus
4 – orbit
5 – temporal lobe (middle cranial fossa)
6 – mastoid air cells
7 – cerebellar hemispheres

5. Normal Brain Anatomy

6. Normal Brain Anatomy 7 – cerebellar hemispheres
7 – cerebellar hemispheres
8 – interhemispheric fissure
9 – frontal horn (lateral ventricle)
10 – falx cerebri
11 – frontal lobe
12 – third ventricle
13 – quadrigeminal plate
19 - thalamus
20 – caudate nucleus
21 – basal ganglia

7. Normal Brain Anatomy

8. Normal Brain Anatomy 8 – interhemispheric fissure
8 – interhemispheric fissure
9 – lateral ventricle
11 – frontal lobe
14 – septum pellucidum
15 - sulci
16 – central sulcus
17 – chorioid plexus
18 – occipital lobe
22 – parietal lobe

9. Hemorrhage

10. Hemorrhage Extra-axial hemorrhage Intra-axial hemorrhage
Epidural hematoma
Subdural hematoma
Subarachnoid hemorrhage
Intra-axial hemorrhage
Intraparenchymal hemorrhage
Intraventricular hemorrhage

11. Epidural Hematoma
Hemorrhage in the potential space between the inner table of the skull and dura matter
Causes
Blunt trauma - injury to middle meningeal artery/vein
95% associated skull fracture
Signs
High-density, Extra-axial
Biconvex lens-shaped mass
Does NOT cross sutures
CAN cross tentorium

12. Epidural Hematoma

13. Subdural Hematoma
Hemorrhage in the potential space between the dura mater and the arachnoid space
Causes
Damage to bridging veins that cross from the cortex to the venous sinuses of the brain
Deceleration injuries (MVA)
Falls (older patients)
Signs
High-iso-low density
Depends on acuity
Concave, crescent shaped
CAN cross sutures
Does NOT cross midline

14. Subdural Hematoma

15. Subarachnoid Hemorrhage
Hemorrhage into the subarachnoid space
Between the pia and arachnoid membranes
Causes
Arteriovenous malformation
Aneurysm rupture
Trauma
Signs
Hyperdense
Within the sulci
and basal cisterns
Intraventricular
blood

16. Subarachnoid Hemorrhage

17. Intraparenchymal Hemorrhage
Hemorrhage within the brain parenchyma
Causes
Hypertensive/Hemorrhagic Stroke
Trauma
Blood Vessel abnormalities
Arteriovenous Malformation
Aneurysm Rupture
Intracranial Neoplasm
Cerebral Amyloid Angiopathy
Coagulopathy

18. Intraparenchymal Hemorrhage
Signs
Well demarcated area of high attenuation
Surrounded by hypoattenuation
Edema
Associated mass effect
Compression of ventricles
Effacement of sulci
Midline shift
Subtentorial herniation
Can have intraventricular blood

19. Intraparenchymal Hemorrhage
Trauma - Closed head injury
Coup (Point of impact)
Shearing of small intracerebral vessels
Countercoup (Opposite the point of impact)
Acceleration/deceleration injuries
Brain propels in the opposite direction

20. Intraparenchymal Hemorrhage
Hypertensive Hemorrhagic Stroke
15% of strokes
Location
Basal ganglia, thalamus, pons, cerebellum

21. Intraventricular Hemorrhage
Hemorrhage in the ventricular system
Cause - Breakthrough bleeding
Brain contusion or subarachnoid hemorrhage
Signs
Most common location
Occipital horns
(lateral ventricles)
Can cause obstructing
hydrocephalus

22. Intraventricular Hemorrhage

23. Brain Tumors

24. Most Common Brain Tumors
Intra-axial mass
Metastasis
Primary intra-axial mass - ADULTS
Glioblastoma multiforme
Primary intra-axial mass – CHILDREN
Medulloblastoma (PNET)
Extra-axial mass
Meningioma

25. Brain Metastasis Most common intra-axial mass Primary Malignancies
Lung, Breast, Melanoma
Signs
Well-defined
Near Gray-White Junction
Multiple or Solitary
Surrounding edema
Enhances with contrast

26. Brain Metastasis SOLITARY MULTIPLE
SOLITARY
MULTIPLE

27. Glioblastoma Multiforme
Gliomas are the most common primary intra-axial malignancy in adults
GBM – most common glioma
Poor prognosis
Male (age 65-75) > Female
Signs
Supra-tentorial
Necrotic and Infiltrative
Cross midline – “butterfly” glioma
Enhances with contrast
Significant vasogenic edema, mass effect

28. Glioblastoma Multiforme

29. Medulloblastoma Most common primary intra-axial tumor in children
Primitive neuroectodermal tumors (PNET)
Male > Female
Peak age 3-5 years
Signs
Infratentorial – Cerebellum
Effacement of the 4th ventricle, basal cisterns
Hydrocelphalus
Hyperdense
Necrosis
+/- Calcifications
Enhances with contrast

30. Medulloblastoma http://reference.medscape.com/article/987886-overview

31. Meningioma Most common extra-axial mass
Benign - Slow growing – good prognosis
Middle-aged Female > Male
Association - NF-2
Signs
Hyperdense
+/- calcifications
+/- edema
Enhance with contrast
Dural Tail

32. Meningioma

33. Please read the supplemental article on cervical spine trauma
Questions?
Please read the supplemental article on cervical spine trauma
Neuro quiz will be administered on Thursday at 11:30AM before conference
Major Text Reference for Power Point:
Learning Radiology: Recognizing the Basics
By William Herring