Professional Documents
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Petr Cech
Basilar skull fractures
Most basilar fractures
occur at 2 specific
anatomic locations
namely, the temporal
region and the occipital
condylar region.
Other Types
Ping-pong skull
fractures .
Traumatic intraventricular
hemorrhage is associated
with diffuse axonal injury,
deep gray matter injury,
and brainstem contusion.
An isolated intraventricular
hemorrhage may be due
to rupture of
subependymal veins .
Cerebral Edema
Severe brain edema or
a large intracranial
hemorrhage may
cause downward brain
displacement and
coning, which is
usually fatal
Stroke
Stroke is a clinical term for sudden, focal
neurological deficit
Hemorrhagic strokes ischemic stroke
due to rupture of a caused by blockage of
cerebral blood vessel blood flow in a major
that causes bleeding cerebral blood vessel,
into or around the usually due to a blood
brain . clot .
account for 16% of all account for about 84%
strokes . of all strokes.
Hemorrhagic Stroke
Hemorrhagic strokes account for 16% of all strokes
Intracerebral hge is Subarachnoid hge, due
the most common, to rupture of a
accounting for 10% of cerebral aneurysm,
all strokes . accounts for 6% of
strokes overall.
Now Dudes tell me what are the reasons of cerebral
hemorrhage!???
1. Hypertensive hemorrhage .
2. Amyloid angiopathy.
3. Ruptured vascular malformation.
4. Coagulopathy(A fluid level within the hematoma) .
5. Hemorrhage into a tumor .
6. Venous infarction.
7. Drug abuse.
Subarachnoid Hemorrhage
Common aneurysm locations include the
anterior and posterior communicating arteries,
the middle cerebral artery bifurcation and the
tip of the basilar artery.
Subarachnoid hemorrhage typically presents as
the "worst headache of life" for the patient .
Ischemic stroke
Ischemic strokes are caused by thrombosis, embolism of
thrombosis, hypoperfusion and lacunar infarctions(1%)
A thrombotic stroke An embolic stroke
(53%)occurs when a (30%) occurs when a
blood clot forms in situ detached clot flows
within a cerebral artery into and blocks a
and blocks or reduces cerebral artery
the flow of blood
through the artery
A CT is 58% sensitive
for infarction within the
first 24 hours (Bryan et
al, 1991). MRI is 82%
sensitive. If the patient
is imaged greater than
24 hours after the event,
both CT and MR are
greater than 90%
sensitive.
After a stroke, edema
progresses, and brain
density decreases
proportionately.
Diffuse Hypodensity and Sulcal
Effacement
Hypodensity in greater
than one-third of the
middle cerebral artery
territory is generally
considered to be a
contra-indication to
thrombolytic therapy.
Hyperdense Vessel Sign
A hyperdense vessel is
defined as a vessel
denser than its
counterpart and
denser than any non-
calcified vessel of
similar size.
This sign indicates
poor outcome and
poor response to IV-
TPA therapy.
Basilar Thrombosis
Thrombosis of the
basilar artery is a
common finding in
stroke patients. CT
findings include a
dense basilar artery
without contrast
injection.
Lentiform Nucleus Obscuration
Subacute Infarction
-Increasing mass effect
- Wedge shaped low
density
- Hgic transformation
After 4 - 7 days the CT
- Gyral enhancement
- Persistent mass effect
In 1-8 weeks:
- Mass effect resolves
- Enhancement may
persist
Chronic Infarction
Case 1
Gunshot injury leading to brain
contusion,localized subarachnoid
hemorrhage & skull fracture at
the site of the bullet entry
Case 2
Depressed skull
fracture,pneumocephaly
Case 3
Subacute subdural hematoma
Case 4
Chronic subdural hematoma with
fluid fluid level secondary to new
bleeding &mix of recent and old
blood
Case 5
Intraventricular
hemorrhage,extending from
intracerebral hge
Case 6
Ischemic cerebral stroke
Hyperdense vessel sign of MCA
Case 8
Chronic cerebral infarction
Case 9
Brain contusion(TBI)