Neuroradiology

Sony Sutrisno
Department of Radiology
Krida Wacana Christian University
 CT- Scan

• Axial / Sagital / Coronal

• Isodens
• Hypodens

• Hyperdens
• Enhancement
Sagital Coronal Axial
Hypodens
Hyperdens
Enhancement
Anatomy
• CC = Corpus Callosum
• L = Ventricle Lateral
• C = Nucleus Caudatus
• G = Globus Pallidus
• P = Putamen
• 3 = Third Ventricle
• T = Thalamus
• A = Auditory Radian
• O = Optic Radian
Anatomy
Cerebro Spinal Fluid
What GP should know?
 SETTINGS
Non-trauma Trauma
• Stroke • Skull fracture
– Ischemic • Contusio
– Hemorrhagic • Subdural Hematoma (SDH)
• Intracerebral • Epidural Hematoma (EDH)
Hemorrhage (ICH)
• Subarachnoid
Hemorrhage (SAH)
• SOLs
– Neoplasm
– Infection (Abscess)
Edema Cerebri
 K E !
T R O
S
 ISCHEMIC

The presence and extent of the ischemic penumbra are time-

dependent, but are especially patient- dependent
Golden Period : generally less than 6 hours, less than 3 hours is
better)
As basis to do or not to do “Thrombolytic therapy”
Imaging modalities : CT-scan & MRI (better)
MRI (DWI seq)  more sensitive (esp. hyperacute setting)
Conventional Radiography has NO ROLE!
Infarct / Ischemic stroke
Hyperacute
 HEMORRHAGIC
• Spontaneous hemorrhage: 10-15% of stroke (US)
• Typically parenchymal, but also may involve
primarily subarachnoid spaces (SAH)
• Spontaneous SAH mostly caused by aneurismal
rupture
• Imaging modalities : CT-scan (primary) and MRI
• CT-scan : rapid, widely available and sensitive (for
acute bleeding, appear as hyperdense lesion)
• MRI : differentiate acute and chronic bleeding,
deeper investigation for the causal
Hemorrhagic Stroke
 EPIDURAL HEMATOMA

Rupture of meningeal artery

Imaging of choice is CT-scan, appears
as convex hyperdense area
Beware of herniation!
Epidural Hematoma
 SUBDURAL HEMATOMA

Rupture of bridging vein: Imaging of choice is CT-scan,

appears as concave hyperdense area
Subdural Hematoma
Subarachnoid Hemorrage
Intraventricular Hemorrhagic
Brain and Bone Window
 SPACE OCCUPYING LESIONs (SOL)
• The disease itself is not true “emergency”
• Could be caused by neoplasm or infection (abscess)
• Mass effect could cause herniation & hydrocephalus!
 the emergency part
• Malignant neoplasm (ex. GBM) often has greater mass effect
than benign one (ex. meningioma)
• Imaging modalities : CT or MRI (better) + CONTRAST!
• Contrast media gives better mass delineation &
characterization
Type of Herniation
 Hydrocephalus
• Communican
• Non communican
Hydrocephalus
Hydrocephalus
Meningitis
Abcess
MRI
DTI
MRS
THANK YOU