Neuroradiologi I

Modul 5.1
TUJUAN
 Memahami modalitas imejing yang digunakan pada kasus
neuroradiologi
 Memahami anatomi SSP
 Memahami gambaran radiologi cerebral ischemia dan infarction :
large artery infarction, cardioembolic infarction, small-vessel or
lacunar infarction, venous infarction
 Memahami gambaran radiologi intracranial hemorrhage :
intraparenchymal hematome ec hipertensi, neoplasma, malformasi
vaskuler
 Memahami gambaran radiologi trauma kepala
 Memahami gambaran radiologi infeksi intrakranial
Modalitas Imejing Neuroradiologi

 X foto cranium
 X foto vertebra
 CT scan
 MRI
 USG
 Angiografi
ANATOMI
ANATOMI
ANATOMI
ANATOMI
ANATOMI
PATOPHYSIOLOGY CEREBRAL ISCHEMIA

 Normal CBF : 50 to 55 mL/100 g of brain tissue per

minute.
 CBF ⇓ ± 15-20 mL/100 g tissue/ min  loss of electrical
activity occurring
 CBF 10 ml/ 100g/min within the first hour  biochemical
response  ⇓ cellular ATP  # ion pumps  Na & K
influx into the cell  osmotic gradient - water influx 
cytotoxic edema : n e u r o n s , a s t r o c y t e s ,
oligodendrocytes.
PATOPHYSIOLOGY CEREBRAL ISCHEMIA

 Endothelial cells do not appear to manifest histopathologic

changes for 4 to 12 hours after ischemic insult  breakdown
blood-brain barrier  vasogenic edema develops ( does not
begin to accumulate until ± 3 to 6 hours after onset of
ischemia )
 requires that there be some residual or reestablished cerebral
blood flow to deliver these products to the extracellular
space.
CEREBRAL ISCHEMIA DAN INFARCTION
 Large artery infarction
ACA, MCA, PCA, PICA, SCA
 Cardioembolic infarction
 Small-vessel or lacunar infarction
small infarct in the deeper parts of brain caused occlusion of a
single deep penetrating artery (>> atherosclerosis)
 Venous infarction
caused by trombosis resuts from occlusion of a venous sinus
and/or cortical vein with predisposing factors are dehydration,
pregnancy, hypercoagulable state and adjacent infection
Hyperacute Ischemic
Stroke INFARCTION
INTRACRANIAL HEMORRAGE

 Intraparenchymal hematome ec hipertensi

 Neoplasma
 Malformasi vaskuler
Intraparenchymal hematome ec. hipertensi
Malformasi vaskuler
Malformasi vaskuler
Neoplasma
TRAUMA

 Fraktur
 Subgaleal hematome
 EDH
 SDH
 Kontusio Hemoragik
 Sub Arahnoid Hemoragik
Fraktur Os Cranium

 Fraktur linier
 Diastase sutura
 Fraktur Impresi
Trauma Vertebra
Trauma Vertebra
Subgaleal Hematome
EDH vs SDH
EDH SDH
Coup side Countre -oup side
Associated skull fracture in 90 % case No consistent relationship to the presence of
skull fracture
Does not cross suture line Does cross suture line
May extend from supra to infratentorial Limited to supra to infratentorial
compartement
May be arterial or venous in origin venous in origin
Medical emergency May be chronic
Magnitude of the mass effect caused by EDH Magnitude of the mass effect caused by SDH
is usually proportional to the size of the is more often associated with underlying
extracereberal collection parenchimal injury
EDH vs SDH
EDH
SDH
CONTUSION HEMORRHAGE
CONTUSION HEMORRHAGE
Infeksi intrakranial
Infeksi intrakranial
Infeksi intrakranial
Infeksi intrakranial
Infeksi intrakranial
Infeksi intrakranial
TERIMA KASIH