Edema Increased water in brain parenchyma Types of
Edema Increased water in brain parenchyma.
Types of Herniations 1. Subfalcine herniation (cingulate gyrus) 2. Transtentorial Herniation (uncal gyral) 3. Tonsillar Herniation
Mass S 1. Tumor 2. Blood clot 3. Abscess 4. Local edema T
Transtentorial Herniation [involve Uncal gyral]
Transtentorial Herniation [Uncus]
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
It can occur as an complication of Lumber Puncture
Complications of Tonsillar Herniation & Increased ICP Hemorrhagic lesion of the mid Brain and Pons : Secondary Brain stem or Duret hemorrhage Linear hemorrhage
Duret hemorrhage: pathogenesis Kinking of the penetrating median and paramedian pontine arteries that branch off the basilar artery.
Duret hemorrhage : causes 1. Tonsillar Herniation 2. Intracranial Neoplasm 3. Intracranial hemorrhage (basal ganglia )
Hydrocephalus Accumulation of excessive CSF within the ventricular system & enlargement
CT scan of Hydrocephalous
Overproduction of CSF (choroid plexus tumor)
Communicating Hydrocephalous. 1. Meningitis. 2. Subarachnoid hemorrhage Obstruction in subarachnoid space
Non communicating Hydrocephalous (Obstructive) 1. Medulloblastoma, 2. Ependymoma No communication between ventricles and subarachonoid space.
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
The gross shows hydrocephalus of the frontal horns of the lateral ventricles.
Hydrocephalous before the fusion of the cranial Sutures [Head circumference increase]
Hydrocephalous after the fusion of the Sutures, produce Ventricular expansion and Increased Intracranial Pressure
Anencephaly 20
Spina bifida Types of spina bifida: A: Spina bifida occulta B: Meningocele C: Meningomyelocele 21
Syringomyelia Note the collapsed cystic cavity (syrinx) in the center of the cervical spinal cord 22
Brain contusion The contrecoup injury involves the frontal and temporal lobes (left arrows) The coup lesion (site of impact) involves the cerebellum (right arrow). 23
Epidural and Subdural Hematoma 24
Red Neuron 25
Border zone infarct: Watershed infarct : Follows a Hypotensive episode. Lesion lies at the boundary between the anterior and middle cerebral artery territories.
Atherosclerotic (thrombotic) stroke 27
Amaurosis fugax 28
Embolic Stroke 29
Intracerebral Hemorrhage 30
Berry Aneurysms 31
Subarachnoid Hemorrhage 32
Lacunar Infarcts The arrows show multiple small cystic spaces (liquefactive necrosis) that are most prominent in the basal ganglia. 33
Lacunar infarcts Cause : Chronic hypertension Site: The pons.
Pyogenic Meningitis
Microscopically, a neutrophilic exudate is seen involving the meninges
Spongiform encephalopathy of gray matter : brain lesion in CJD
Complications: sequel 1. Edema can lead to herniation and death. 2. Communicating hydrocephalous.
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.
Neutrophils in the abscess.
Abscess in the brain in a patient who had septicemia.
Atrophy There is marked atrophy seen superiorly and laterally.
The cortical atrophy leads to compensatory dilation of the cerebral ventricles [hydrocephalus ex vacuo ]
Self Study For anatomy, not for exam
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