CNS Case Discussion

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CNS Case Discussion

• 365 RAD

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Intracranial Bleeding

• Extradural
• Subdural
• Subarachnoid
• Intraventricular
• Intraparenchymal

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EDH

• 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

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EDH

• Arterial 90, Venous 10
• Nontraumatic-rare
• Lucid interval-50
• C/F headache, nausia, vomiting, convulsions,
  herniation.

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SDH
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SDH

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

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SDH

• Trauma is the most common cause
• Acute 6hr-3d
• Subacute 3d-3w
• Chronic gt3w

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SDH
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SDH
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Blood in the suprasellar cistern
Blood in the interhemispheric fissure
Blood in the ambient cistern
Blood in the sylvian fissures
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SAH

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

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Parenchymal bleed

• Causes
• HTN, trauma, AVM, aneurysm, permaturity, tumors,
  infarction, coagulopaty.

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Trauma
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Trauma
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Courtesy Osborn AG
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Courtesy Smithuis R
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FLAIR

• DWI

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Intracranial herniations

• Subfalcine
• Transtentorial
• Unilat/Bilat

Osborn AG
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Intracranial herniations
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Brain edema

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

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Brain edema

• Imaging findings
• Hypodensity on CT
• Low signal on T1, high signal on T2 FLAIR
• Loss of GM/WM interface
• Compressed ventricles
• Effaced sulci Cisterns
• Dense cerebellum
• Brain herniation
• Vascular compression-ischemia

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Brain edema
3w later
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Brain edema
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Brain edema
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Brain edema
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Brain edema
Cytotoxic Vasogenic
Gray matter White matter Location
Restricted Non-restricted DWI
Diffuse Finger-like Shape
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Compressed lateral ventricle
Obliterated CSF space
Normal sulci
Subdural hematoma
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• Intracranial bleeding
• Brain infarctions
• Brain edema/herniation

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