CNS Pathology
RT 91
Fall 2011
Final
CRANIAL FRACTURES
Cranial Fractures
 Cerebral
fractures usually occurs to
fractures of the calvaria of the skull
 3 types of cranial fractures

____________- straight and sharply defined
• Is 80% of all cranial fractures

____________- curvilinear density

____________- Air fluid levels are indicative
• Hard to diagnosis radiographically
Cranial Fractures
 Location
of FX is more important that the
extent of the FX


If FX crosses artery a bleed can occur
causing a hematoma
Fx that enters mastoid air cells or sinus can
cause an infection that can result in
• Meningitis
• Encephalitis
_______ Fractures

Non branching lines that
are intensely radiolucent

Vascular markings are
occasionally mistaken for
fractures

Fracture appears more
translucent and
transverses the full
thickness of skull

Sutures
__________________
__________ Fracture

The fractured edges
________

Usually caused by a high
velocity impact with a
small object

Can cause bleeding into
______________ space

Best demonstrated with
CR __________to the FX
_____________ Skull FX
_______________Fracture

Very difficult to demonstrate with x-ray



__________________ in sphenoid sinuses
Clouding of ________________________________
Often X-table lateral is done to demonstrate this
 CT & MRI are most often used for this type
TRAUMATIC DISEASE

Has protective membranes that
enclose the brain and spinal cord

Dura Mater- outer most layer
• Tough and fibrous

Arachnoid = middle layer
• Has appearance of cobwebs

Pia mater = innermost layer
• highly vascular and closely
adhered to cortex and spinal
cord

Subarachnoid space = wide
space between arachnoid and
pia mater
• Filled with CSF
• Bathes brain & spinal cord with
nutrients
• Cushions against shocks and
blows
Meninges
Meninges Diagram

Four irregular
interconnected- fluidcontaining cavities



Cerebrospinal fluid (CSF) =
tissue fluid of the brain and
spinal cord that surrounds and
cushions CNS
Ventricles communicate with
each other through
connecting channels
Lateral ventricles = one on
each side of MSP in
corresponding hemispheres
of cerebrum
Ventricular
System

Interventricular foramen =
connects lateral ventricles to
third ventricle

Also called foramen of
Monroe

Third ventricle is slitlike cavity
somewhat quadrilateral in
shape

Situated in MSP, just
inferior to lateral ventricles

Cerebral aqueduct = connects
third and fourth ventricle; also
called aqueduct of Sylvius
Ventricular
System
Cerebral ______________
 Is
an injury to the brain tissue caused by a
____________ of the brain within the
calvaria after ______________________
 Occurs
when brain contacts rough skull
surfaces such as _______&___________


PT usually loses consciousness and cannot
remember traumatic event
Persitent LOC over 24 hrs is a coma and can
be fatal
Cerebral
Contusion

Treatment:

PT is hospitalized
• Prevent shock


Clinical symptoms:





Drowsiness
Confusion
Agitiation
Hemiparesis
Unequal pupil size
If there is swelling
medication is given to
decrease cranial
pressure
• Control edema
• Draniage of hematoma

Surgery is usually not
necessary
Cerebral ________________
Hematomas

Brain trauma often resulting in a hemorrhaging
from a ruptured ______________________



__________bleeding occurs more slowly than arterial
bleeding
_________bleed accumulates fast & causes
neurologic symptoms & coma
Both can cause edema in the brain and cause an
increase in intracranial pressure

Skull does not allow for expansion and pressure
forces brain toward open space (foramen
magnum)

Can result in major consequences & death if not
treated quickly
______________Hematomas

Highest mortality relate of the hematomas


Results from a torn _________ and its branches



Even when treated quickly mortality rate is 30%
Most often occurs from a FX of the _______ bone
80% of cases conventional radiograph shows fracture
Usually _______________ with blood pooling
between bones of the skull & _______________
____________Hematoma
Usually a shift of midline
Toward ________ side
CT shows increased
density
Emergency surgical
decompression is required to
relieve cranial pressure
_______________ Hematomas
 Between

the __________&___________
Caused by blunt trauma to frontal or occipital
lobes and can tear ____________________
 Pushes
brain away from skull across
midline (including ventricles)
_____________Hematoma
Occurs more slowly
Because it is a ________
Hemorrhage.
On CT appears as a
curvilinear area of I
increased density on
portions or all of the
cerebral hemispheres
______________Hematomas
 Subacute

 In


stage (up to several days)
Appears on CT as a decreased density or
isodense fluid collection
chronic state (2-3 weeks)
The surface of the hematoma becomes
concave
Delayed coma cn occur
Symptoms of Hematomas
 Headaches
 Agitation
 Drowsiness
 Gradual
radiograph deficits
Treatment of Hematomas

In small hematomas without inclination to
rebleed



Severe cases



the hemorrhage is reabsorbed naturally
no treatment is necessary
Require surgical ligation
Evacuation of hematoma to prevent herniation
Less invasive treatment may include


Drug therapy
Intraventricular catheter to remove CSF, which may
cause herniation
Gunshot Wounds
Gunshot Wound
_______________

Can be _______________ or
________________
 Refers to an excessive amount of fluid in the
ventricles
 Two types

_______________________________
• Interferes or blocks normal CSF circulation from the
ventricles to the subarachnoid space

_________________________________
• Poor absorption of the CSF by the arachnoid Villi

Least common cause is from overproduction of CSF
_________________________

Non-communicating




Can be congenital
Can be from tumor
growth
Trauma (hemorrhage)
Inflammation

Communicating




Can come with
increased cranial
pressure
Raised intrathoracic
pressure impairing
venous flow
Inflammation from
meningitis
Subarachnoid
hemorrhage
Radiographic Appearance

Generalized enlargement of the ventricular system

PA radiograph can reveal separation of the
___________

CT clearly demonstrates ventricular dilatation

MRI is more specific in demonstrating the underlying
cause of obstruction or in excluding obstruction

Ultrasound is useful in utero and in infants

Sound waves transverse open fontanels
Hydrocephalus
Hydrocephalus
Hydrocephalus Clinical Symptoms





The cranial size is
enlarged
Scalp veins distended
Skin of scalp thin,
fragile and shiny
Neck muscles
underdeveloped
•In adults
Severe cases
•ALOC
 Orbital roofs are
•Ataxia
depressed
•Incontinence
 Eyes displaced
•Decreased intellectual
downwards
•capabilities
Treatment of Hydrocephalus

Placement of a ________


Internal jugular, heart or
peritoneum
Contains one way valve to
prevent backflow of blood
into ventricles

Radiographs taken to
verify _______________

CT or MRI done to
evaluate success of
treatment
Hydrocephalus in Infants

Affects 1 of every
1000 newborns

Long maturation of
CNS

Can be caused by
maternal & fetal
infections, fetal
hypoxia, irradiation,
chemical agents and
mechanical forces
Vascular Disease
________________________

Is an atherosclerotic disease affecting blood
supply to the brain
 ______________leading cause of death in U.S.
 2 types of stroke:


Both CT and MRI distinguish between the two
types



___________________________________
MRI is especially sensitive to infarction within hours of
onset
CT, at times appears negative for a day or so
Carotid duplex and MRA are also useful in the
diagnosis of a stroke
________________ Stroke

Blood clot blocks a blood vessel in the brain
 Is the majority of strokes

Two types:

____________________ of cerebral artery
• Blood clot that blocks a blood vessel

____________________ of the brain
• Is a mass of undissolved matter (solid, liquid or gas) present
in a blood vessel brought there by blood current

Diagnosed with CT and MRI

Angiography can be used if other modalites are
questionable
Symptoms of ________
__________Stroke

Sypmtoms come on over horus to days




Confusion
Hemiplegia
Aphasia
May be preceded by a temporary episode of
nerurologic dysfunction called transient ischemic
attack (TIA)

Includes hemiparesis, monocular blindness- clears up
in about 2 hours
Ischemic Stroke: from ______

___________ onset of symptoms without
warning

Mortality rate is_______________

Prognosis depends on location, extent, age, and
general health



Complete recovery is rare
Deficits remaining after 6 months are likely to be
permanent
Treatment


Bed rest
Clot blockers within 3 hours (recombinant tissue
plasminogen activator (rtPA)
Ischemic Stroke
________________ Stroke

Occurs from a __________ in the diseased
blood vessel

Typically weakened from atheroscleosis from
hypertension

Sudden and often lethal because it comes on so
suddenly

Accounts for _____________of all CVA’s

Two types:

_______________-&___________________
Hemorrahgic Stroke

Most occur in the ________ and bleed into
lateral ventricle

Most often preceded by an intense headache
and vomiting

LOC follows in minutes and leads to
contralateral hemiplegia or death

Prognosis is poor


___________ die day after stroke
___________die within a few weeks, usually from
another vessel rupture
Treatment of
Hemorrahgic Strokes
 Surgery

 If
Preceded by a surgical angiogram
surgical intervention is postponed so will
the angiogram
Hemorrahgic Stroke
Neoplastic Disease
___________ ____________
Pituitary Adenoma
Acoustic Neuroma
Acoustic Neuroma
Metabolic Disease
•X-ray
of affected bones show
cortical thickening with a
coarse
•Thickened
trabecular pattern
•Often
called ___________
appearance
•Mixed
areas of ___________
&__________________ areas
__________
__________
________________Disease
__________ Disease
1.
_____________ disorder of unknown cause
2.
Has two stages:
1.
2.
_______________
_______________
3.
Fairly common in elderly
4.
Affects men twice as frequently as women
54
Malignancy
_________ ___________