Radiology of common brain diseases 366 RAD 1

Scope Lecture 1 n Intracranial bleeding n Brain ischemia n Brain edema Lecture 2 n Intracranial tumors n Brain infections n Brain inflammation 2

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Intracranial Bleeding Extradural n Subarachnoid n Intraventricular n Intraparenchymal n 6

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EDH n n n n Blood collection between inner table and dura. Biconvex (lentiform) Occur at site of impact 95% unilateral, supratentorial Does not cross sutures Can cross falx and tentorium Skull fracture in 90% Air seen in 20% 8

EDH Arterial 90%, Venous 10% n Nontraumatic-rare n Lucid interval-50% n C/F: headache, nausia, vomiting, convulsions, herniation. n 9

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SDH n n n Blood collection between dura and arachnoid. Crescent shape Supratentorial Cross sutures, but not dural attachments May extend along falx and tentorium 11

SDH Trauma is the most common cause n Acute: 6 hr-3 d n Subacute: 3 d-3 w n Chronic: >3 w n 12

SDH 13

SDH 14

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Blood in the suprasellar cistern Blood in the interhemispheric fissure Blood in the ambient cistern Blood in the sylvian fissures 17

SAH Blood between pia and arachnoid n Traumatic (most common) n Nontraumatic n C/F: headache, vomiting, blurred vision, neck rigidity n Complications: hydrocephalus (acute/delayed), vasospasm, rebleeding. n 18

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Parenchymal bleed Causes: HTN, trauma, AVM, aneurysm, permaturity, tumors, infarction, coagulopaty. n 22

Trauma 23

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Trauma 25

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Courtesy: Osborn AG 27

Courtesy: Smithuis R 28

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T 2 WI FLAIR DWI 40

FLAIR DWI 41

Brain edema n Vasogenic: n n Trauma/infection/inflammation/tumors Cytotoxic: n Ischemia/trauma • Both could be generalized or localized • Both may co-exist 42

Brain edema n Imaging findings: Hypodensity on CT n Low signal on T 1, high signal on T 2 & FLAIR n Loss of GM/WM interface n Compressed ventricles n Effaced sulci & cisterns n Dense cerebellum n Brain herniation n Vascular compression-ischemia n 43