5. Note how the subdural bleed (left side) has compressed the ipsilateral
ventricle resulting in a compensetory expansion of the contralateral
ventricle.
Used with permission by the CRASH Trials with credit to Mr. J. Wasserberg and Mr. B. Mitchell
6. Terms beginning with A – M
Terms beginning with N - Z
8. Process where by increased intracranial pressure
forces brain parenchyma through a fixed opening.
Clinical scenarios:
Transtentorial herniation (aka “uncal” herniation)
▪ Medial temporal lobes (uncus) and brainstem are forced through
the tentorium
▪ Symptoms include headache, decreased consciousness, pupillary
dilation and may progress to extensor posturing and death
Cerebellar herniation (rare)
▪ Cerebellar tonsils are “pushed” into the foramen magnum
▪ Similar symptoms as transtentorial herniation
9. The cerebrum is the largest part of the brain and is
responsible for thought and abstraction.
The cerebrum is divided in four “lobes”. Some
authors include the insula as the fifth “lobe” of the
cerebrum
The outer layer of the cerebrum (cortex) is gray
matter (lacks myelin)
10. Anterograde amnesia = Loss of memory for an event
or events immediately following a head injury.
Retrograde amnesia = Loss of memory for an event or
events preceeding a head injury.
11. From the Greek Arachnoid granulations
arakhnoeid’s,
(cobweblike)
Villous projects of
the pia-arachnoid
membrane whose
function is to
absorb CSF and
return it to the
venous circulation
via the superior
saggital sinus.
12. A thin membrane
adherent to the dura
mater.
The arachnoid
membrane is the middle
layer of the three
meningial layers (dura
mater, arachnoid
membrane, and pia
mater) that surround the
brain and spinal cord.
13. The basasl ganglia consists of three gray matter
structures (caudate, putamen, and globus pallidus)
deep within cerebral hemispheres
Lentiform nuclei = putamen and globus pallidus
Functions as motor relay stations
Pathology in the basal ganglia results in
purposeless movements (Parkinson’s disease)
14.
15. The basilar artery provides blood to the posterior
aspect of the Circle of Willis and is formed from the
paired vertebral arteries. Supplies blood to the
pons, cerebellum, and posterior cerebrum.
16. The circle of Willis is a term used to describe
the arterial supply for the brain. The circle is
derived from the two internal carotid arteries
as well as the basilar artery, the latter being
the continuation of the two vertebral arteries.
24. From Latin (“box”).
A well defined collection of CSF within the
subarachnoid space (located between the pia and
arachnoid membranes).
Several cisterns are generally described and two
are of importance in the CT head:
Suprasellar - (Star-shaped) Location of the Circle of Willis
Quadrigeminal - W-shaped at top of midbrain
25. The corpus callosum is the structure that
connects the left and right cerebral
hemispheres.
26.
27. The dorsum sellae is the square shaped part of
the sphenoid bone that forms the posterior
boundary of the pitutary fossa.
29. Latin (“hard Dura Mater Epidural hematoma
Brain
mother”)
The outer,
fibrous
portion of
the
meninges.
30. A reflexion of the dura
mater located between
the cerebral
hemispheres. Function
is to provide support to
the cerebral
hemispheres.
31. The rounded, elevated convolutions on the surfaces
of the cerebral hemispheres.
32. The insula is one of the
five cerebral cortices
(frontal, parietal,
temporal, occipital,
insular) and is located
deep to the frontal,
parietal, and temporal
lobes. Function is to
integrate autonomic
functions.
33. Collection of axons
that carry sensory
information to the
cortex and motor
information to the
cord.
The internal
capsule is very
sensitive to stroke
34. Aka “medulla oblongata”
Located in the brain stem and sits below the
pons and in front of the cerebellum.
Functions to help control autonomic function,
especially heart rate and breathing.
35.
36. Includes the midbrain, pons, and medulla.
Major function is survival (breathing,
digestion, heart rate, blood pressure) and for
arousal (being awake and alert).
38. Pneumocephalus (see
red arrow) is the
presence of air (or gas)
within the cranial
cavity and is usually
associated with a
basilar skull fracture
39.
40. The sutures are fibrous connections between
bones of the skull
Sutures allow for some flexibility of the
cranium
Fontanelles (aka “soft spots”) are unfused
areas where sutures meet
Sutures ossify at various times throughout
life
41. The pons sits between the brainstem and
medulla
Controls rate and depth of breathing
Relays impulse from medulla to cerebrum
Clinical pathology results in:
Bilateral, fixed, pinpoint pupils (comatose patient)
Cheyne-Stokes breathing
▪ Hyperventialtion followed by apnea
42.
43. The uncus is the medial (innermost) portion
of the temporal lobe
Under high intracranial pressure (ICP) the
uncus can be involved in a transtentorial
herniation syndrome
ICP pushes the uncus through the tentorium
cerebelli which results in compression of the
brainstem
44. 1. The brain squeezes under
the falx cerebri in
cingulate herniation
2. The brainstem herniates
caudally
3. The uncus and the
hippocampal gyrus
herniate into the tentorial
notch
4. The cerebellar tonsils
herniate through the
foramen magnum in
tonsillar herniation
45.
46. The ventricles are CSF-containing cavities
Provides a protective cushion (buoys the
brain)
CSF produced in roof of ventricles (choroid
plexes)
Circulation of CSF through ventricles and
around the brain (subarachnoid space) and
cord (central canal) with reabsorption in
arachnoid villi
47.
48. The thalamus is the central relay station for
sensory fibers (except olfactory)
Cerebral cortex communicates with thalamus
Responsible for primitive emotional responses
Fear
Pleasant vs. unpleasant stimuli
49.
50. The temporal lobes are one of the five cortical
lobes
The temporal lobes are responsible for hearing,
speech, and some emotional and memory
functions
51. Lain – “groove” or “trench”
Pleural – “sulci” (sul-sigh)
The small cracks or dimples on the surface of the
brain
52. The septum
pellucidum is a thin
midline structural
membrane
The septum runs
vertically between the
lateral ventricles as
well as inferiorly from
the corpus callosum
53.
54. Aka “superior sagittal sinus”
Large collection of venous blood above and behind the
brain
Attached to the falx cerebri
Receives CSF from the arachnoid granulations
55.
56. The posterior fossa is an area within the intracranial
cavity bound by the tentorium cerebelli above and
foramen magnum below
The posterior fossa contains the cerebellum and
brainstem structures
57. Aka “pineal body”
The pineal glad is an endocrine gland that
produces melatonin and is important in sleep-wake
cycles
58.
59. The parietal lobe is the cortical lobe responsible for
sensation (cutaneous and muscular)
Responsible for integration of thoughts and
feelings
60.
61. The functional tissue(s) (key elements) of an organ
62. The occipital lobe is the cortical lobe responsible
for vision
Integration areas for visual images with sensory
experiences.
Dura matter (tentorium cerebelli) separates the
occipital lobe from the cerebellum
63. The putamen is part of the basasl ganglia
The basals ganglia consists of three gray matter
structures (caudate, putamen, and globus pallidus)
deep within cerebral hemispheres
Lentiform nuclei = putamen and globus pallidus
Functions as motor relay stations
Pathology in the basal ganglia results in
purposeless movements (Parkinson’s disease)
64.
65. CT head is currently the procedure of choice for
evaluation of suspected stroke
Stokes are either hemorrhagic (minority) or
nonhemorrhagic (vast majority of cases)
Nonhemorrhagic strokes = “ischemic” strokes
The latter, if diagnosed quickly, can (potentially) be
treated with thrombolytic agents
The CT can reliably serve to rule out intracranial
hemorrhage
The CT is examined for evidence of vascular
occlusion (clots), edema, and hemorrhage
71. Hemorrhagic strokes are due to rupture of a
cerebral blood vessel
Bleeding can occur into or around the brain
Blood may extend into the ventricular system
Hemorrhagic strokes account for 16% of all
strokes
Hypertensive hemorrhage accounts for
approximately 70-90% of non-traumatic primary
intracerebral hemorrhages
72. Etiologies include thrombus, embolism, or
hypoperfusion
Ischemic brain tissue becomes edematous
Edematous tissue will appear hypodense on
noncontrast CT
Hypodensity begins as early as 1h post-CVA
▪ Earliest sign of CVA is loss of gray-white differentiation (the "insular
ribbon" sign)
Hypodensity is completely manifest by 12-24 hours post-
CVA
73. Obscuration of the lentiform nuclei
Hypoattenuation of the insular ribbon
Sulcal effacement and cortical hypodensity
Hyperdense vessel signs
74. Lentiform nuclei =
globbus palladus and
putamen (parts of the
basal ganglia)
Edema from ischemia
produces hypodenity of
basasl ganglia structures
within hours of event
Red arrows denotes
hypodensity of the basal
ganglia structures
(compare to opposite
side)
75.
76. An occluded vessel
(thrombus) may
appear ”dark” on CT
The red arrow
denotes a dense
basilar artery
77. Red arrows point to
hypodensity and sulcal
effacement.
Note the generalized
edematous appearance
of the tissues within
the middle cerebral
artery distribution
78. Moderate - severe head trauma is an indication for a
CT head scan
Some controversy exists as to when a CT should be
obtained for a “minor” head injury in adults:
Canadian CT recommendations
New Orleans Criteria
For infants and children:
Considerations
General recommendations
79. Things to Think About
Interpretation Mnemonics
Order of Evaluation (basic)
Bone windows
Blood (intracranial hemorrhage)
Brain parenchyma
Ventricles
Cisterns
80. Introduction
CT considerations and clinical importance
Diagrams
Ventricular anatomy
CSF circulation
CT images
Normal lateral ventricles
Normal third ventricle
Ventriculomegaly
Ventricular compression and enlargement
81. Brain parenchyma = brain “tissue”
The brain parenchyma is symmetrical
Gray and white matter should be well defined
Edema results in poor delineation
Midline structures (falx cerebri, third and fourth
ventricles) should not be deviated
Deviated midline structures is evidence of mass effect =
edema, bleeding, tumor
Check the parenchyma for evidence of blood
82. General considerations
CT images
Normal midline structures
Midline shift
Cerebral edema
83. Notice the
sharp
difference
between the
large
hypodense
edematous
(red arrows)
tissue and the
remaining
“normal”
cortical tissue
84. Used with permission by the CRASH Trials with credit to Mr. J. Wasserberg and Mr. B. Mitchell
85. Noncontrast study is standard
A contrast study will be so designated on the CT images
Most scanners are now “ultrafast” and can perform a
head CT in less than one minute
Scan spans from the base of the occiput to the top of
the vertex in 5-mm increments
Three sets of data are derived from the primary scan:
Bone windows (fractures)
Tissue windows (gray/white matter density)
Subdural windows (brain bleed)
89. CT MRI
Fast, easy, available, and Slower and more expensive
relatively cheap Soft tissue and joints
Study of choice for Spine and spinal cord
Posterior fossa and orbits
suspected brain bleed
Better for CNS
Generally good for solid developmental
organs and bleeds applications
Good study for chest, Can’t be used with certain
abdomen, and pelvis pacemakers and (metal)
pathology implants
Radiation exposure
90. Relative Density (Attenuation)
Radiation Exposure
CT protocols
Noncontrast (“standard”)
With contrast (“enhanced”)
91. IV contrast – general considerations
Clinical indications
Contraindications
92. I.V. contrast is given to differentiate blood vessels
from soft tissue and organs
Blood and falx appear white with contrast
Original ionic contrast agents have largely been
replaced with nonionic agents (fewer reactions)
Iodine reactions were actually responses to the carrier
molecule of the contrast rather than iodine
Risk related to IV contrast:
Anaphylaxis ~ 1:10,000
Death ~ 1:40,000 – 100,000
NPO X 4 hours before administration of IV
contrast
Depends on urgency of exam
93. Quick
Easy
Available
Inexpensive (fairly)
Standard of care for closed head injury
evaluation
Shows bony calvarium well
▪ Bone windows can show fractures easily
94. “The five B’s” “Blood Can Be Very Bad”
Blood Blood = blood
Brain Can = cisterns
Bone Be = brain
Balloons (ventricles) Very = ventricles
Boxes (cisterns) Bad = bone
95. Just like a standard X-ray, the CT shows
dense objects (bone) as white and less dense
objects (air) as black.
The concept of relative density is known as
attenuation and is measured in Hounsfield
Units (HU)
96. Structure Hounsfield Units
Bone + 1,000
Blood + 50-100
Gray matter + 32 - 46
White matter + 22 - 36
CSF + 4 - 10
Water 0
Air -1,000
Clincal caveat: The radioglogist can place the computer cursor
on any part of the CT image and determine the exact HU
density – a real time way to differentiate blood from abscess
from CSF, etc.
97. The CT scan is a sophisticated x-ray that
literally takes a continuous x-ray as it moves
around the patient (tomogram)
The X-ray source and detector unit are
situated opposite of each other
360 degree movement around the patient
Very thin x-ray beams are utilized
The CT computer integrates the assembled x-
ray information and produces a “relative
density” map that we view as a gray-scale
image.
98. Type of Exposure Dosage (mSv)
Background radiation 3 mSv/year
CXR 0.1 mSv
CT head 2 mSv
CT chest 8 mSv
CT abdomen and pelvis 20mSv
Caveat: A CT head is the equivalent of 20
CXRs, while a CT abdomen & pelvis equals
200 CXRs! Yikes!
99. General considerations
CT Description
CT images
Normal supracellar cistern
Normal quadrigeminal cistern
Compression of supracellar cistern (early)
100. Notice how the right uncus is pushing into the supracellar cistern.
Dx: Early uncal herniation from increased intracranial pressure
101. From Latin (“box”)
Collections of CSF within the subarachnoid space
(between the pia and arachnoid membranes)
Cistern pathology is usually seen on CT as
compression or presence of blood
Compression
▪ Increased intracranial pressure (herniation symndrome)
▪ Mass effect (tumor)
102. Several cisterns are described but two are of
importance in the CT head:
Supracellar cistern
▪ Star-shaped (“super star”)
▪ Location = Circle of Willis
Quadrigeminal cistern
▪ W-shaped (looks like a baby’s bottom)
▪ Location = Level of tentorium cerebelli
103. A. Falx Cerebri
B. Frontal Lobe
C. Anterior Horn of Lateral Ventricle
D. Third Ventricle
E. Quadrigemina Cistern
F. Cerebellum
Can you visualize the
“baby’s bottom”?
104. Notice how the
falx is deviated
(white arrow)
due to a space
filling lesion
(red outline)
105. Developed from a series of patients ( > 16
years-of-age) presenting with minor head
injury (defined as GCS score of 13-15 after loss
of consciousness, definite amnesia, or
witnessed disorientation from trauma)
Clinical criteria consist of five high-risk and
two moderate-risk factors.
106. Obtain CT Head if patient has > one the following
seven:
GCS score lower than 15 two hours after injury
Suspected open or depressed skull fracture
Any sign of basal skull fracture
Two or more episodes of vomiting
Age 65 years or older
Retrograde amnesia > 30 minutes
Dangerous mechanism
Motor vehicle involved
Fall from a height of at least three ft or five stairs
107.
108.
109. CT is needed if the patient > one of the following:
Headache
Vomiting
Age older than 60 years
Drug or alcohol intoxication
Persistent anterograde amnesia (deficits in short-term memory)
Visible trauma above the clavicle
Seizure
*Applicable for adults with a normal Glasgow Coma Scale score of 15 and blunt
head trauma that occurred within the previous 24 hours that caused loss of
consciousness, definite amnesia, or witnessed disorientation.
110. Evaluate the significance of the injury by physical
findings AND mechanism of injury
Kids have heavy heads and weak necks
Younger children are less likely to be symptomatic
Signs of significant head injury can be subtle
(persistent irritability)
Scalp hematomas in infants and toddlers suggest
significant injury
111. All moderate and severe head trauma
Any loss of consciousness
Age under 3 months
Skull fracture (intracranial injury in 15-30%)
Scalp hematoma predicts fracture (>80% sensitivity)
Depressed mental status
Focal neurologic deficits
Bulging fontanelle
Persistent irritability after head injury
Seizure following head injury
Recurrent vomiting after injury
112.
113. Bone windows for fractures
Brain tissue
Hemorrhage or masses
Symmetry
Midline shift
Edema
Ventricles
Compression, blood, or hydrocephalus
Subarachnoid cistern compression
114. The head contains four things (skull, brain,
blood, spinal fluid)
The CT is reviewed to make sure all four are in the
right amount and location
The brain is symmetrical; asymmetry is
abnormal
The cerebral hemispheres are mirror image
structures - what is on the left should be on
the right
115. Prior contrast reaction (“iodine allergy”)
Poor renal function
Creatinine > 2.0
Lack of consent
Suspend breast feedings for 24 hours
following I.V. contrast
Shellfish and/or Betadyne allergies
are not contraindications
116. A. Orbit
B. Sphenoid Sinus
C. Temporal Lobe
D. External Auditory Canal
A. Orbit E. E. Mastoid Air Cells
Mastoid Air Cells
B. Sphenoid Sinus F. F. Cerebellar Hemisphere
Cerebellar Hemisphere
C. Temporal Lobe
D. External Auditory Canal
Used with permission University of Virginia Health Sciences Center
117. A. Frontal Lobe
B. Frontal Bone
(Superior Surface of Orbit)
C. Dorsum Sellae
D. Basilar Artery
E. Temporal Lobe
F. Mastoid Air Cells
G. Cerebellar Hemisphere
118. A. Frontal Lobe
B. Sylvian Fissure
C. Temporal Lobe
D. Suprasellar Cistern
E. Midbrain
F. Fourth Ventricle
G. Cerebellar Hemisphere
Used with permission University of Virginia Health Sciences Center
119. A. Frontal Lobe
B. Falx Cerebri
C. Anterior Horn of Lateral
Ventricle
D. Third Ventricle
E. Quadrigeminal Plate
Cistern
F. Cerebellum
Used with permission University of Virginia Health Sciences Center
120. A. Anterior Horn of the Lateral Ventricle
B. Caudate Nucleus
C. Anterior Limb of the Internal Capsule
D. Putamen and Globus Pallidus
E. Posterior Limb of the Internal Capsule
F. Third Ventricle
G. Quadrigeminal Plate Cistern
H. Cerebellar Vermis
I. Occipital Lobe
Used with permission University of Virginia Health Sciences Center
121. A. Genu of the Corpus Callosum
B. Anterior Horn of the Lateral Ventricle
C. Internal Capsule
D. Thalamus
E. Pineal Gland
F. Choroid Plexus
G. Straight Sinus
Used with permission University of Virginia Health Sciences Center
122. A. Falx Cerebri
B. Frontal Lobe
C. Body of the Lateral Ventricle
D. Splenium of the Corpus Callosum
E. Parietal Lobe
F. Occipital Lobe
G. Superior Sagittal Sinus
Used with permission University of Virginia Health Sciences Center
123. A. Falx Cerebri
B. Sulcus
C. Gyrus
D. Superior Sagittal Sinus
Used with permission University of Virginia Health Sciences Center
124. Supracellar cisterrn
(can you visualize the “star” shape)
Fourth Ventricle
F = frontal lobes
U = uncus (medial temporal lobes)
Po = Pons
128. Majority are due to aneurysms or
arterioventricular malformations (AVM)
Bleeding is into the CSF space
Ability to diagnose with CT decreases with
time:
▪ 95% positive at 12 hours
▪ 80% positive at 3 days
▪ 30% positive at two weeks
130. Below the dura but above the arachnoid
Usually venous in origin
Commonly a ruptured bridging vein (dural drainage)
Cresent or sickle shaped pattern on CT
Can cross suture lines
Common in elderly or anti-coagulated
Density of blood determines the age of the bleed:
Acute
Chronic
131. aka “intracerebral” hemorrhage
Can follow hypertensive stroke
Can follow deceleration (“contusion”) injuries
Can extend into the ventricles (intracerebral
extension)
132. Hemorrhage into the ventricular system
Can be an extension of an intraparenchymal
or subarachnoid bleed
Can be secondary to trauma (poor outcome)
Not uncommon in extremely premature
infants
Obstructive hydrocephalus can be a
complication
133. Arterial blood
Usually secondary to a linear skull fracture through an arterial
channel (like the middle meningeal artery)
Biconvex shape (lens shaped)
Bleeding may cross the midline
Bleeding won’t cross suture lines
A subdural and an epidural may occur together
Epi vs. sub doesn’t matter – but volume does
> 5 mm or > 10 mm in adults = surgical evacuation
135. Haydel MJ, Preston CA, Mills TJ, Luber S,
Blaudeau E, DeBlieux PM. Indications for
computed tomography in patients with minor
head injury. N Engl J Med. 2000;343:100-5.
Stiell IG, et al. Comparison of the Canadian
CT Head Rule and the New Orleans Criteria in
patients with minor head injury. JAMA.
2005;294:1511-8.
www.aafp.org/online/en/home/clinical/clinica
lrecs/headinjurychild.html
137. Fracture in any
location other than
parietal location
Non-linear fracture
Linear fracture length
exceeding 6 cm
Fracture crossing
suture lines
138.
139. The bone windows information is part of the routine CT
head and is ideal for viewing fractures
Sinuses can be seen well with bone windows
The scout film of the CT scan is roughly the equivalent of
a lateral skull x-ray film – so look at it too
Remember to look at the overlying soft tissue for
swelling as it may point to an underlying skull fracture
140. Skull fractures may be classified as either linear or
comminuted
Inwardly displaced comminuted = depressed skull fx
▪ A depressed skull fracture requires immediate neurosurgical
evaluation
Cranial sutures can be confused with linear fractures
141. Suture Fracture
Characteristic locations Usually
temperoparietal
Symmetrical line on other side Asymmetrical
Same size throughout Widest at the center/
narrow at the end
Graceful curvy lines Straight lines with
angular turns
142. A fracture of the orbital roof, sphenoid bone,
or mastoid portion of temporal bone
Usually resolve on their own but can be:
Displaced
Cranial nerve damage (II, VII, VIII)
CSF leak (otorhea or rhinorhea)
“Classic” clinical findings may (or may not) be
present
143. Hemotympanum
Periorbital bruising ("raccoon eyes“)
Cerebrospinal fluid otorrhea or rhinorrhea
Battle's sign (Mastoid eccymoses)
Pneumocephalus
(Air and fluid/levels in sinuses)
144. Superior to inferior
Falx cerebri
Body of lateral ventricles
Internal capsule and thalamus
Caudate and third ventricle
3rd Ventricle and quadrigeminal cistern
Supracellar cistern and 4th ventricle
145. Extra-axial hemorrhage Intra-axial hemorrhage
(outside the brain) (inside the brain)
Subarachnoid (SAH)
Epidural
Below the arachnoid membrane
Below the skull
On the surface of the brain
“above” the dura Intraparenchymal (IPH)
Subdural Within the substance of the
Below the dura brain
Above the thin, spidery-like Intraventricular (IVH)
arachnoid membrane Within the ventricles
146. CSF-filled balloons CSF Direction of Flow:
CSF is produced in the Lateral ventricles
choroid plexes, Foramen of Monroe
“circulates” through Third ventricle
the ventricular system, Cerebral aqueduct
percolates over the Fourth ventricle
surface of the cord and Foramen (Magendie and
brain, and is absorbed Lushka)
in the arachnoid Subarachnoid space
granulations Arachnoid granulations
Venous circulation
147. Size
Large = too much fluid or brain atrophy
Small = Compression (edema or mass)
Symmetry
Asymmetry = impingement from mass/edema, etc.
Presence of blood
IVH can lead to secondary hydrocephalus
Anatomic landmarks
Lateral and 3rd ventricle are supratentorial
▪ 3rd is located anterior to the pineal gland
▪ Looks like an exclamation point
4th ventricle is infratentorial
▪ Looks like a pith helmet (roundish)
149. A tough, fibrous structure separating the
cerebrum above and the cerebellum and
brain stem below
Provides support for the cerebrum
Structures above the tentorium are known as
supratentorial or anterior fossa
Structures below the tentorium are known as
infratentorial or posterior fossa
157. Majority can be visualized without contrast
Contrast is indicated if brain tumor is suspected and
not see on noncontrast study
Appear as edematous, low density, poorly-
defined lesions
Classified as intraaxial (within the brain tissue) or
extraaxial
Adult tumors are usually supratentorial while
pediatric tumors are usually infratentorial
Many metastatic tumors will be located at the
gray-white matter border(s)
159. Cystic mass in the
midline of the
cerebellum (red
arrows)
Note early
hydrocephalic
changes
secondary to
tumor
compression
(yellow arrows)
160. Red arrow
points to a
large
cerebellar
hemorrhage
Used with permission University of Virginia Health Sciences Center
161. Cocaine induced
hypertensive CVA
Note the large
hemorrhagic lesion
in the left cortical
area as well as
multiple smaller
regions (redness)
near the
hippocampus and
other cortical
regions.
www.utsa.edu/tsi/assign/anat/neuropat.htm
162. Loss of the gray-
white interface in
the lateral margins
of the insula
The cortex of the left
insular ribbon is not
visualized (arrow).
Right insular ribbon
is outlined in yellow
163. Contrast enhanced CT
of meningioma (most
common extraxial
brain tumor)
164. Used with permission by the CRASH Trials with credit to Mr. J. Wasserberg and Mr. B. Mitchell
165. A. Falx Cerebri
B. Frontal Lobe
C. Body of the Lateral
Ventricle
D. Splenium of the Corpus
Callosum
E. Parietal Lobe
F. Occipital Lobe
G. Superior Sagittal Sinus
Used with permission University of Virginia Health Sciences Center
166. Edema
The darker gray
Edema
areas represent
Blood
Blood edema while the
white areas
represent the
intracerebral
contrusion
(“bruise”)
Used with permission by the CRASH Trials with credit to Mr. J. Wasserberg and Mr. B. Mitchell
167. Used with permission by the CRASH Trials with credit to Mr. J. Wasserberg and Mr. B. Mitchell
168. Small red arrows point
to a biconvex epidural
hematoma secondary
to a skull fracture (large
red arrow)
Used with permission University of Virginia Health Sciences Center
169. Red arrows denote
blood within the sulci
of the right cerebral
convexity
Used with permission University of Virginia Health Sciences Center
170. The large red arrow
points to blood within
the ventricle while the
smaller red arrows
point to blood in the
sulci (subarachnoid
hemorrhage)
Used with permission University of Virginia Health Sciences Center
171. Linear skull fracture
(parietal location)
found on bone
windows image
173. The cortical areas of the
brain devoted to motor
(frontal motor strip) and
sensory (parietal sensory
strip) function can be
represented as an “upside”
down person.
A disruption in cerebral
blood flow to these areas
will result in a
corresponding sensory
and/or motor deficit to the
corresponding region.
174. Artery Lobes Supplied Deficit
ACA Frontal Leg weakness
MCA Frontal Speech
Lateral Temporal Motor and sensory
Lateral Parietal to hand and arm
PCA Temporal Visual defects
Occipital