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sections would be
cutting with a knife like this is I'm
showing.
You can see immediately in these fresh
sections
that there are different colors, if you
will
to the central nervous system.
In the brain, there is this grey matter
and this white matter.
You can see a more greyish hue, and a
whitish hue.
In the brain, the grey matter is on the
outside,
whereas the white matter is mainly located
on the inside.
In the spinal cord, you'll see just the
opposite; the white
matter is on the outside, and the grey
matter is located centrally.
So what's going on here?
What is the difference between the gray
and the white matter?
Well in order to understand this, let's
first
review what's going on on a cellular
level.
This is a cartoon of the neuron.
The most important cell but not the only
cell.
In our central nervous system.
And it is made up of a cell body here,
with a nucleus in the middle.
So the cell body with a nucleus.
And then a long axon that allows it to
talk
to other nerve cells and other different
types of cells.
Please note that this diagram is a
cartoon,
in part, because it's quite out of
perportion.
In reality, in many cases, the axons
are extraordinarily long compared to the
cell body.
I'm sitting today in San Francisco, and if
I were a cell body,
given my size.
My axon might stretch across the bay to
Burkley California.
Quite a distance of some many miles.
So axons in reality are much, much longer
than you see depicted here.
There are some confusing terminology in
neuroanatomy that should be defined.
It turns out that identical structures in
the central nervous system and the
peripheral
nervous system.
Are given different names.
the pia.
In life, in health, these are merely
potential spaces where there
is small amount of fluid, or nothing,
sitting in these spaces.
But in disease, we often see problems with
these
spaces that are defined by these
connective tissues layers.
I'd like to illustrate the clinical
relevance of these spaces by talking
about a real life example and that's the
unfortunate case of Natasha Richardson.
You may recall that Ms. Richardson was a
famous actress, the
wife of Liam Neeson and although we don't
know the clinical
details personally of the case, there's a
lot to be learned
from the reports that are in the
newspapers regarding this sad story.
Ms. Richardson was a 45 year old woman
just four
or five years ago who suffered a fall
while skiing.
It turns out she was skiing On nothing
more than a relatively small bunny slope.
And she fell.
She fell and hit her head.
Initially she felt well.
She refused
medical treatment and went back to her
hotel room.
But then three hours later, she developed
a severe headache and progressively became
confused.
She was then taken to a local
hospital after emergency medical personnel
were summoned.
And then she was air lifted to a tertiary
center in Canada.
Before being air lifted to a tertiary
center in the United States.
And hours
later, this healthy woman who falls and
has something
that sounds like a relatively minor head
trauma, is dead.
So what happened here?
What is this injury that led to a healthy
woman with a head trauma dying
hours later who afterwards, just after the
injury was doing fine?
Well here's an example of a CT scan for
the same condition that Natasha
Richardson.
Suffered from.
First of all, let me orient you to
Neuroanatomy
You'll hear more about Neuroradiology and
Neuroanatomy later on
in the course, but let me just orient you
that over here is right and over here is
left.
You see the R and the l on your screen.
Remember that all neuro images have the
same orientation.
It's as if, if you're taking slices of the
head like so.
You are standing at the person's feet and
looking up
towards their head if they are lying down
on a gurney.
Therefore you can imagine the right would
be here, the left would be here.
Remember that orientation.
On a CT scan, a non-contrast CT
scan, everything that's white is something
to pay
attention to.
This white limb around the brain is merely
the skull.
On a CT scan The skull is bright, and you
know it's a CT scan because you see this
bright skull.
That's nomal.
But what's not normal is this lens-shaped
opacity here.
This bright, white area is blood.
This is acute blood.
This is bleeding that has occured in the
brain, and in fact this
bleeding That is in the epidural space.
That space that lies between the skull and
the dura that in health,
does not have any blood in it, but here is
an epidural hematoma.
Remember, that's this space here lying
between the bone and the
dura and you can imagine that if there's a
collection of fluid here, our bone,
at least in adults, is unforgiving.
The bone, the skull, will not stretch out.
That won't happen.
If fluid, blood in this case, accumulates
what will happen, is there'll be
forces that will push on the brain, and
the brain will be pushed in.
With potentially devistating consequences.
In the case of an epidural hematoma, there
are many arteries that could be damaged.
But the, classic question, when somebody
gets hit in the
head and has an epidural hematoma, is what
artery is injured.
It's often the so called, middle meningeal
artery.
That you see represented here.
A branch of the external carotid artery
that feeds some of the face and the skull
for instance.
Where meningitis, inflammation of the
meninges, scars down The arachnoid layer.
And therefore scars down these arachnoid
villi, so they can't normally absorb.
In the case of communicating
hydrocephalus,
all the ventricles would be enlarged
symmetrically.
Because the problem is not one or more of
them
being obstructed, rather it's at the end
of this pathway.
Not being able to absorb spinal fluid.
So here's an example of obstructive
hydrocephalus, you see the
patient right here has a mass sitting in
his brain.
In this case it's a large anerysim.
And you see that the ventricular system,
above that, is quite enlarged and
asymmetrically so.
With the left-hand side of the ventricular
system being much more enlarged than the
right-hand side
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