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CNS Emergencies

This document discusses various neuroemergencies that can be evaluated with radiology. It covers skull fractures, hemorrhages such as extra-axial and parenchymal bleeds, cerebral infarctions, and spinal trauma. For each condition, it describes the recommended imaging tests and indications. CT and MRI are important for evaluating hemorrhages, infarctions, and fractures. The document provides examples of imaging findings for different types of hemorrhages, infarctions, and spinal injuries.

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Evhita Nugroho
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195 views46 pages

CNS Emergencies

This document discusses various neuroemergencies that can be evaluated with radiology. It covers skull fractures, hemorrhages such as extra-axial and parenchymal bleeds, cerebral infarctions, and spinal trauma. For each condition, it describes the recommended imaging tests and indications. CT and MRI are important for evaluating hemorrhages, infarctions, and fractures. The document provides examples of imaging findings for different types of hemorrhages, infarctions, and spinal injuries.

Uploaded by

Evhita Nugroho
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Radiology in Neuroemergency
Dr Neni Irianty SpRad (K)RA
CNS Emergencies

 Skull Fractures

 Hemorrhage (traumatic/non-traumatic)

- extra-axial

- Parenchymal

• Cerebral Infarction

• Spinal Trauma
Skull Fractures

What to order :

• Plain X-Ray of the skull (AP-Lat view)

• Computed Tomography of the Brain (axial-coronal)


with Bone window and 3D reconstruction

When :

History of trauma –evident injury of the scalp


PLAIN X-RAY
CT SCAN
CT SCAN
HEMORRHAGE

 Traumatic and Non Traumatic

 What to Order :

Computed Tomography (CT) of the Brain


Plain

• When :
Head Trauma – focal neurological Defect
Hemorrhage : Trauma

 Findings in :

- Extra Dural Blood

- Subdural Blood

- Cerebral Contusion
Epidural Hematoma
Subdural Hematoma
EDH VS SDH
Cerebral Contusion

Intraparenchymal contusion
Diffuse Axonal Injury

CT MRI
Hemorrhage : Non Traumatic

 Findings in :

- Subarachnoid Blood

- Intraparenchymal Blood

- Intraventricular Blood
Etiology SAH

 Trauma : most common


 Spontaneous :
- Ruptured aneurysms (75%-80%
- Cerebral AVM
- CNS vasculities
- Cerebral artery dissection
- Coagulation disorders
- Dural sinus thrombosis
Subrachnoid Hemorrhage
SAH
Intraparenchymal Hemorrhage
Hypertensive Hemorrhage
Vascular Territory
Intraventricular Hemorrhage
IVH
IVH and SAH
IVH as complications of Prematurity

 Germinal Matrix Hemorrhage


 Germinal matrix is a highly vascular weakly
supported structure that is prone to rupture and
hypoxic-ischemic injury
 >50% IVH occurs in first 24 hours of life, 90% by 10
days.
 The term IVH refers to 4 grades

 Diagnosis using sonography


GMH grade 1 GMH grade 2
GMH grade 3 GMH grade 4
Cerebral Infarction

 What to order :

- Computed Tomografi (CT) of the brain .


CTAngiography ,CT-perfusion
- Magnetic Resonence Imaging (MRI) : DWI
MR Angiography
* When :
Focal Neurologic defet – stroke
CT 0f infarct
Acute to Chronic
MCA infarct
MRI
MRI : DWI
Cerebral Infarction, etiology

 Thrombotic occlusion : due to atherosclerosis and it


leads to infarction

 Embolic occlusion : due to thrombo-embolic from


cardiac chambers and it leads to hemorrhagic
infarction.

 Small vessel disease : related to hypertension and


arteriosclerosis, it leads to lacunar infarction
(multipel small infarction)
Hemorrhagic infarction
Brain Herniation
Spinal Trauma

 Vertebral Fracture
 Spinal cord Injury
What to order ?
- Plain X Ray of the spine (Ap and lateral view)
- CT of the spine (bone and soft tissue-3D recon)
- MRI of the spine (for cord injury)
When ?
History of spina trauma – falling from height.
X-Ray
CT
CT 3D recon
Odontoid Fracture

X Ray CT
Spinal Cord Injury
Spinal Cord Injury
Spinal cord injury case
THANK YOU

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