Neuroradiology for psychiatrist

Computerized Tomography
CT scans measure density of the tissues Hyperdense and hypodense refer to brighter and darker areas, respectively Structures of intermediate density similar to brain tissue appear gray and are called isodense

Non contrast

Contrast

What can be seen by CT scan

Hemorrhage (EDH, SDH, SAH, ICH) Infarction Neoplasm Mass effect Infection ( meningitis , encephalitis , abscess )

Epidural hematoma (EDH)

Traumatic brain injury Bleeding between skull and dura (artery bleeding) Appearance : Biconvex lens Clinical : headachefocal signcomadeath

Subdural hematoma (SDH)

Usually associated with traumatic brain injury Bleeding between dura and arachnoid mater(venous bleening : bridging veins) Cresent- shaped on CT scan Clinical course : acute subacute chronic Risk factors : Alcohol , eldery , antiplatelet , anticoagulant

Signs and symptoms

Loss of consciousness or fluctuating levels of consciousness Disorientation Irritability Seizures Headache (either constant or fluctuating) Numbness
Amnesia Weakness Personal change Ataxia Gait disturbance Urinary incontinence Nausea and vomiting Blurred vision Dizziness

Acute SDH

Subcute SDH

Chronic SDH

Chronic SDH

Subarachnoid hemorrhage (SAH)

Bleeding between arachnoid and pia mater Causes : spontaneous (rupture aneurysm ) , trauma Clinical Thunderclap headache Vomiting Confusion Seizure Coma

Intracerebral hemorrhage (ICH)

Cause Trauma Nontrauma HT hemorrhage ( thalamus, basal ganglion, pons, cerebellum) AVM rupture Bleeding tumor Clinical : location

Thalamic hemorrhage with intraventricular hemorrhage and hydrocephalus

Cerebellar hemorrhage with intraventricular hemorrhage

Normal pressure hydrocephalus

Adams triad or Hakim's triad Gait instability Dementia Urinary incontinence DDx PD AD Vascular dementia

Cerebral infarction
Sudden onset of
Weakness ( facial weakness , limbs weakness , dysarthria) Aphasia Numbness Ataxia Alteration of consciousness Visual disturbance (blindness , visual field defect, double visions)

Circle of Willis

Arterial supply of brain

 Acute cerebral infarctions often cannot be seen by CT scanning in the first 6 to 12 hours Cell death and edema lead to an area of hypodensity seen in the distribution of the artery Persistent areas of hypodensity in the brain tissue resulted of gliosis and of brain necrosis with replacement by CSF

Middle cerebral artery(MCA) syndrome

Hemiparesis/Hemiplegia or arm weakness Hemianesthesia Aphasia in dominant hemisphere(Motor, sensory, conductive, transcortical ,or global aphasia) Neglect , anosognosia or apraxia in nondominant hemisphere Homonymous hemianopia

Middle cerebral artery infarction

Anterior cerebral artery(ACA) syndrome

Hemiparesis/Hemiplegia primarily leg Henianesthesia primarily leg Apraxia, disconnection syndrome Urinary incontinence

Anterior cerebral artery infarction

Posterior cerebral artery(PCA) syndrome

Homonymous hemianopia Cortical blindness Hemianesthesia or dysesthesia (thalamic pain) Visual agnosia, prosopagnosia Memory deficit

Posterior cerebral artery infarction

Vertebro basilar system syndrome

Hemiparesis or quadriparesis Cranial nerve abnormality Hemiparesis or total anesthesia Vertigo, nausea, and vomiting, along with nystagmus Ataxia or dysmetria Horners syndrome

Brainstem infarction

Magnetic resonance imaging (MRI)

Atomic nuclei (person) placed in a static magnetic field and then probed with a pulse of magnetic energy Hydrogen (protons) is the most abundant element in biological tissue The intensity of MRI signals determine the proton density and relaxation time

T1-weight

T2-weight

fluid attenuation inversion recovery (FLAIR)

DWI (diffusion weighted imaging )

Measure the diffusion of water protons in brain tissue Sensitive in acute ischemic stroke within 30 minutes Bright on DWI ( restricted on DWI)

Acute Left parieto-occipital infarction

MRI in patient with dementia

Alzheimers disease Frontotemporal lobe dementia Normal pressure hydrocephalus Vascular dementia Dementia with Lewy bodies

MRI finding in dementia

Alzheimers disease

Normal

Elephant sign in AD

Alzheimers disease

CT brain

Frontotemporal lobe dementia

Normal pressure hydrocephalus

T2 weight

FLAIR

Vascular dementia
Large vessel infarctions Bilateral in the ACA territory Parietotemporal- and temporo-occipital association areas of the dominant hemisphere (angular gyrus included) Posterior cerebral artery territory infarction of the paramedian thalamic region and inferior medial temporal lobe of the dominant hemisphere

Vascular dementia
Watershed infarctions in the dominant hemisphere (superior frontal and parietal) Small vessel disease
Multiple lacunar infactions in frontal white matter (>2) and basal ganglia (>2) WMLs (at least more than 25% of WM) Bilateral thalamic lesions

Vascular dementia

Vascular dementia

PCA infarction involving medial temporal lobe

MRI in parkinsonism
Multiple system atrophy Progressive supranuclear palsy Wilsons disease Huntingtons disease

Progressive supranuclear palsy(PSP)

Humming bird sign' due to midbrain atrophy

Humming bird sign and Mickey mouse sign in PSP

Normal

Multiple System Atrophy(MSA)

Wilsons disease

Midbrain : Face of Giant panda sign

Wilsons disease

Pons :face of the miniature panda

Huntingtons disease

Caudate atrophy

White matter lesion in NPSLE