neuro radiology

• Plain X-rays are almost defunct now.  It uses radiation to obtain an image by shining an X-ray beam on the head and projecting the image of a skull onto a film.  It only gives you bone detail and you cannot tell what is inside the head.

  
• Nowadays, it is not even indicated for identifying skull fractures because a skull fracture in itself tells you nothing except that the patient has had a significant injury to cause a bone to crack.  What is more important is what goes on inside the head as a result of trauma.  Hence a CT scan is more useful here.

  
• Do we still do skull X-rays?  Very occasionally.  Mainly to look at the bone abnormalities and also for looking at the settings of an intraventricular shunt

  
• In assessing the brain, xrays are useless

  
• Xrays still used for facial bones

  
• what is this

  A) Haemorrhage in maxillary sinus

  
• general anatomy

  A) skull

  B) CSF

  C) sulci

  D) grey matter

  E) white matter

  F) ventricles

  G) chordate nucleus

  H) lentiform nucleus

  I) thalamus

  J) blood

  
• CT

  Rapid access & fast imaging (1 minute)

  Good for differentiating soft tissues, fluid, blood, air and bone

  CT head is almost always performed WITHOUT contrast

  
• CT - planes

  A) axial

  B) sagittal

  C) coronal

  
• The brain is symmetrical (anatomically)

  
• Orientation of imaging is important and follows this convention whether we are dealing with CT/MRI/plain x-ray.

  Left and right?

  A) right

  B) left

  C) right

  D) left

  
• brain anatomy

  A) dural infolding called the falx cerebri

  B) central sulcus

  C) frontal lobe

  D) parietal lobe

  E) central sulcus

  F) precentral gyrus = motor cortex

  G) postcentral gyrus = sensation

  
• what is this

  A) frontal lobe

  B) parietal lobe

  C) lateral ventricle

  D) occipital

  
• what is this

  A) occipital horn

  B) occipital lobe

  
• what is this

  A) temporal lobe

  B) midbrain

  C) cerebellum

  
• what is this

  A) dural infoldings called the tentorium cerebelli

  B) cerebellum

  C) midbrain

  D) pons

  E) medulla oblaganta

  
• what is the small white stuff

  A) choroid plexus

  B) 3rd ventricle

  C) pineal gland

  
• pineal gland doesn't show up white in children as it calcifies at about 18-20
• what is this little channel called

  A) cerebral aqueduct

  
• what are these

  A) pons

  B) 4th ventricle

  C) cerebellum

  
• what are these

  A) middle cerebral artery

  B) Sylvan Fissure

  C) frontal lobe

  D) temporal lobe

  
• what are these

  A) sphenoid sinus

  B) Sellar turcica

  C) pituitary gland

  D) clivus

  E) occipital bone

  F) foramen Magnum.

  
• CT allows 3D skull image

  
• what is this - happening outside the dural space.

  A) extra dural hemorrhage

  
• what is this?

  extra dural haemorrhage due to a temporal bone fracture, gas can be seen and it bleeds due to meningeal arteries which are adherent to the skull

  
• Sudden Onset Headache

  A) Left middle cerebral artery aneurysm

  B) subarachnoid hemorrhage

  
• Sudden Onset Headache - subarachnoid hemorrhage link

  
• Angiography

  Access the arterial system through the groin and advance the catheter up to the aortic arch (when thinking about arterial supply, always start at the aorta).
• Angiography MRI

  
• CT Angiography Both 3D and 2D

  
• CT aneurysm

  A) saccular

  B) ruptured

  C) fusiform

  D) aneurysm

  
• MRI Head  T1

  Fluid dark

  Grey matter – Grey

  White matter - White

  
• MRI Head  T2

  Fluid bright – WW2

  Grey matter – white

  White matter - grey

  
• MRI Head

  
• Sudden Onset Right Arm And Leg Weakness - stroke

  CT film looks normal apart from the middle cerebral artery being a bit denser

  
• Sudden Onset Right Arm And Leg Weakness - stroke

  MRI T2 shows Edema inside the temporal and parietal lobes

  
• Multiple episodes of weakness and paraesthesia

  abnormal white blobs in the white matter - edema

  A) Multiple Sclerosis

  
• Head ache and increasing left sided weakness

  A) tumours

  B) glioblastoma

  C) metastasis

  
• Xray - neuro

  Facial bone fractures

  Not used for skull fractures
• CT - neuro

  First line in most neuro pathology

  Trauma

  Stroke – to exclude haemorrhage

  Sudden headache

  Progressive headache