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BASIC ANATOMY AND PHYSIOLOGY OF THE BRAIN AND
THE NERVOUS SYSTEM
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þThe primary functions of the human nervous
system are to monitor, integrate (process) and
respond to information inside and outside the
body.
þThe brain consists of soft, delicate, ÷ ÷
÷
.
THE BLOOD SUPPLY TO THE BRAIN
The major arteries are :
ANTERIOR CEREBRAL ARTERIES
ANTERIOR COMMUNICATING ARTERY
INTERNAL CAROTID ARTERIES
MIDDLE CEREBRAL ARTERIES
ANTERIOR CHOROIDAL ARTERIES
POSTERIOR COMMUNICATING
ARTERIES
POSTERIOR CEREBRAL ARTERIES
SUPERIOR CEREBELLAR ARTERIES
BASILAR ARTERY
VERTEBRAL ARTERIES
form the
,
THE MENINGES
The brain is wrapped in O OO
The innermost O
Omembrane contains the blood vessels.
The brain is nourished and cushioned by cerebrospinal fluid, which is contained between
O O
O and the
O.
The outermost membrane lines the inside of the skull and is comparatively
thick and tough. , it encloses the
OO
O
þOnly one dose of radiation is necessary and specialized software packages are used
to manipulate the acquired information as desired to best demonstrate the
patho/physiology.
þSpiral CT can also be used to demonstrate bleeds and also allows for m
to demonstrate abnormalities of the blood vessels , for example
aneurysms and arteriovenous malformations.
þ If a CT is indicated, skull x-rays are not necessary and may only cause delay.
BRAIN HAEMORRHAGES
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Epidural/ Extradural Haemorrhages (Haematoma)
Õ or Õ
is caused by TBI, in which a buildup of blood occurs
between the
and the skull. The dura mater also covers the spine, so epidural
bleeds may also occur in the spinal column. EDH commonly results from acceleration-
deceleration trauma and transverse forces. EDHs are extra-axial bleeds.
An EDH occurs when there is a rupture of a blood vessel, usually an artery, but can be a vein.
The affected vessels are often torn by skull fractures. Venous epidural bleeds are usually due
to shearing injury from rotational or linear forces, caused when tissues of different densities
slide over one another.
EDH is potentially deadly because the buildup of blood may increase pressure in the
intracranial space (
), and compress delicate brain tissue. If the
patient is not treated with prompt surgical intervention, death is likely to follow.
The bleeding is usually acute and of high attenuation and there is often significant mass effect
with
of the ipsilateral lateral ventricle and of the opposite lateral
ventricle due to obstruction of the
(interventricular foramen). The basal
cisterns may be effaced.
Epidural haematoma is usually found on the same side of the brain that was impacted by the
blow, but on very rare occasions it can be due to a contrecoup injury.
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ïig 1.This is the typical appearance and location of an acute ïig 2. This example shows a more unusual, lower location. Note also
extradural haematoma. the gas within the haematoma - this indicates a basal skull fracture or,
Note the high density of the haematoma. Slight midline shift is as in this case, it is post surgical. Note also the dilated lateral ventricle
present on the opposite side.
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ïig 1 ïig 2
fig 4
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Fig. 3 Right frontal acute EDH with an air bubble, and midline shift.
Fig. 4 shows a 3 D CT image demonstrating skull fractures.
On March 18, 2009, actress Natasha Richardson died as a result of an
epidural hematoma sustained two days earlier while skiing in Mont-
Tremblant, Québec, Canada. Like many patients, she had a lucid
interval where she did not exhibit any symptoms until approximately
an hour after her fall when she complained of a headache. By the
time she reached medical care, the hematoma had already caused
significant damage.
An
is a rapidly clotting blood collection below the inner layer of the
but external to the brain and
membrane,(extra-axial) often
from ruptured veins crossing this potential space.
The blood is again of high attenuation, but may spread more widely in the
subdural space, with a
appearance and a more
margin on CT.
EXAMPLES Oï SUBDURAL HAEMATOMAS
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Chronic(hypodense)subdural
The bleeding occurs in the arteries that run underneath the
membrane,
thereby damaging the brain tissue. The reduction of blood supply can also cause
further brain damage, leading to disruption or loss of brain function and possibly
death.
A
, can lead to further bleeding from damaged blood
vessels; a complication associated with a 70% fatality rate.
due to restricted circulation of cerebrospinal fluid, follows
approximately 15% of subarachnoid hemorrhages. Because cerebrospinal fluid
cannot drain properly, pressure accumulates on the brain, possibly prompting further
ischemic complications.
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, (m ) occurs within the brain tissue itself, i.e. it is
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; that is, it occurs within the brain tissue rather than
outside of it.
Intracerebral bleeds are the second most common cause of stroke. High blood pressure
raises the risk of spontaneous intracerebral hemorrhage.
bleeds due to trauma are usually due to
, but
can also be due to
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The risk of death from an intraparenchymal bleed in traumatic brain injury is especially high
when the injury occurs in the
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bleeds within the
are
almost always fatal, because they cause damage to the vagus nerve, which plays an
important role in and breathing. This kind of haemorrhage can also occur
in the
or areas, usually in the
lobes when due to
head injury, and sometimes in the
.
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. HAEMORRHAGIC CONTUSIONS
These occur due to stretching and shearing injuries, often
due to impaction of the brain against the skull on the side
opposite to the injury.
Thus they may be seen directly opposite the impact
site, subcutaneous haematoma, fracture, or
extradural haematoma (contre coup injury).
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Multiple contusions may be present throughout the cerebral
hemispheres.
They are often very small and visible at the grey/white matter
interface.
They are due to a shearing injury with rupture of small
intracerebral vessels, and in a comatose patient with no other
obvious cause they imply a severe diffuse brain injury with a poor
prognosis.
Larger haemorrhages may occur in severe trauma, and they may
not be apparent on a scan performed immediately after the injury,
only becoming prominent after a day or two. MRI is more sensitive
to diffuse brain injury, particularly in the absence of haemorrhage.
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CT ANGIÊGRAPHY ÊF THE VESSELS ÊF THE BRAIN
SHÊWING ANEURYSMS
RECÊNSTRUCTED BY RADIÊLÊGIST DR S MURPHY
SÊME ACTIVITIES TÊ STAY AWAY FRÊM
REïERENCES
1. Ben Pansky,Ph.D.,M.D.1975. ͞ Review of gross Anatomy.͟
2. Retrieved from "http://en.wikipedia.org/wiki/Cerebral_hemorrhage"
3. University of Vermont College of Medicine. "Neuropathology: Trauma to
the CNS." Accessed through web archive. Retrieved on February 6, 2007.
4. Brain injury victims can seem OK, symptoms delayed, Associated Press, March
19, 2009 http://www.biomedcentral.com/1471-2377/7/1
l MedlinePlus - Intracerebral hemorrhage Update Date: 7/14/2006. Updated by:
J.A. Lee, M.D.
' Downie A. 2001. "Tutorial: CT in Head Trauma". Retrieved on ïebruary 6, 2007.
7. Wagner AL. 2006. "Subdural Hematoma." Emedicine.com. Retrieved on
ïebruary 6, 2007.
8. Shepherd S. 2004. "Head Trauma." Emedicine.com. Retrieved on ïebruary 6,
2007
9. http://www.neurologyindia.com/article.asp?issn=0028.http://en.wikipedia.org/
wiki/Epidural_hematoma, Categories: Neurotrauma | Neurology.
We've made great medical progress in the last
generation. What used to be merely an itch is
now an allergy.
THANK YOU