RachmayastiKelvin

AnatomiNormal

gray matter Cerebrospinal fluidwhite matter bonebone

bonebone

Blood Can Be Very BadADAKAH / BAGAIMANA :Blood : DarahCan : CisternsBe : BrainVery : VentriclesBad : Bone

A. Falx CerebriB. SulcusC. GyrusD. Superior Sagittal Sinus*

Gambaran Peningkatan TIK pada CT ScanMidline shiftingPenyempitan cisterna (basalis dan perimesensefalik)Kompresi ventrikelDilatasi ventrikel kontralateralDilatasi ventrikel simetris (bila ada obstruksi letak rendah)

Skull Fractures Fractures must be distinguished from sutures that occur in anatomical locations (sagittal, coronal, lambdoidal) and venous channels. Sutures have undulating margins both sutures and venous channels have sclerotic margins. Venous channels have undulating sides. Depressed fractures are characterized by inward displacement of fracture fragments. *Linear skull fracture of the right parietal bone (arrows).

Subarachnoid Hemorrhage *High density blood (arrowheads) fills the sulci over the right cerebral convexity in this subarachnoid hemorrhage.

Subarachnoid Hemorrhage *High density blood (arrowheads) fills the sulci over the right cerebral convexity in this subarachnoid hemorrhage.

Acute Subdural Hematoma

High density, crescent shaped hematoma (arrowheads) overlying the right cerebral hemisphere. Note the shift of the normally midline septum pellucidum due to the mass effect arrow. *The hypodense region (arrow) within the high density hematoma (arrowheads) may indicate active bleeding.

Subacute subdural hematomaSubacute subdural hematoma (arrowheads). Note the compression of gray and white matter in the left hemisphere due to the mass effect.

Epidural Hematoma (EDH)Lesi bikonveks >> regio temporoparietalTidak akan menyeberangi suturaAir bubbles fraktur terbukaBisa terjadi coup atau contre coupMidline shifting kontralateralE/C ruptur A. meningea media dan percabangannya

SDH AkutLesi hiperdens bikonkaf / crescent / semiluner, dengan tepi dalam mengikuti alur gyri Bisa melewati suturaEfek massa yang >> dan tidak sebanding dengan jumlah perdarahanE/C ruptur dari vena subdural (bridging veins)Bisa : TraumatikNon traumatik : org. tua, hipertensi

SDH KronisTipe I : hipodense (33%) semua komponen padat sudah diabsorbsiTipe II : mixed or inhomogenous density (33%)Tipe III : isodense (25%)Tipe IV : slightly hyperdense (7-10%) antara hari ke-12 s/d minggu V

SDH Kronis Hipodense(Tipe I)Semua komponen padat sudah diabsorbsiLesi hipodens dengan HU = LCS pada konveksitas kranium

SDH Kronis Inhomogenous or Mixed densitySDH kronis bbrp minggu s/d tahunLiquefaksi darah dan resorbsi densitas menurun (7 HU / hari) dan semakin lama ada area yang menjadi semakin hipodens inhomogenous or mixed density

Di mana letak lesi ?? lihat ventrikel yang terkompresiSubdural Hematoma (SDH) Kronis Isodense

Subarachnoid Hemorrhage (SAH)Lesi hiperdense pada :Fissura SylviiFissura interhemisferik (hati-hati pd org tua)Sulkus kortikalisCisternaBisa :TraumatikSpontan : hipertensi, AVM, aneurysma (pd usia muda)

Intracerebral HemorrhageLesi hiperdens pada parenkim otakBisa :Traumatik : kortikal atau subkortikallobus frontal atau temporal anteriorMultiple2-3% letaknya dalam (biasanya di Ganglia basalis)Stroke hemorrhagik : letak lebih dalamsering di ganglia basalis

Intraventricular Hemorrhage (IVH)Penyebab :ruptur ICH ke intraventrikelperdarahan vasa plexus choroideus dan sub ependymalrefluks dari SAH

Ada fluid-blood level

Intracerebral Hemorrhage (ICH) dan SAH e/c Ruptur AVMLesi hiperdens dengan gambaran spt cacing di dalamnya disertai SAH dan odema perifokal!! : Perdarahan intracerebral pada usia muda Kontras : gambaran bag of worms pada nidus

Diffuse InjuryAdanya lesi hemoragik +/- efek massa pada substansia alba subkortikal, corpus callosum, ganglia basalis, atau batang otakGbr lain : odema diffuse, SAH, IVH

Klasifikasi DIGrade I : tidak ada lesiGrade II : ada lesi 25 ml yang tidak mungkin dievakuasi scr bedah

Hemorrhagic Contusion + SDH dan SAH (DI Grade III)ICH traumatika yang biasanya multiple, scattered pada parenkim otak

Odema Cerebri (DI Grade III)Gbr hipodens luas pada parenkim cerebrum Adanya perbedaan densitas parenkim otak dengan struktur infratentorial (cerebellum)White cerebellum sign

ICH + SDH + SAH (DAI Grade IV)

Cerebral Contusion Cerebral contusions are the most common primary intra-axial injury. They often occur when the brain impacts an osseous ridge or a dural fold. The foci of punctate hemorrhage or edema are located along gyral crests. The following are common locations: - Temporal lobe - anterior tip, inferior surface, sylvian region - Frontal lobe - anterior pole, inferior surface - Dorsolateral midbrain - Inferior cerebellum.On CT, cerebral contusion appears as an ill-defined hypodense area mixed with foci of hemorrhage. Adjacent subarachnoid hemorrhage is common. After 24-48 hours, hemorrhagic transformation or coalescence of petechial hemorrhages into a rounded hematoma is common. *

Multiple foci of high density corresponding to hemorrhage (arrows) in an area of low density (arrowheads) in the left frontal lobe due to cerebral contusion. *

Fraktur CraniumFraktur linierFraktur depresi / impresi : fragmen masuk intrakranialFraktur diastasis : pelebaran sutura

Fraktur Basis CraniiDiskontinuitas pada tulang-tulang yang menyusun basis craniiSering disertai perdarahan pada sinus paranasalis (hematosinus)

Fraktur Multiple pada Basis dan Calvaria CraniiFraktur linier Fraktur depresi / impresi : fragmen masuk intrakranialFraktur diastasis : pada sutura tampak sutura melebar

InfarkLesi hipodens pada parenkim otakPada perifer : wedge area sesuai percabangan vasa darah otakSering pada ganglia basalis dan capsula externa / interna

Infark HemisferLesi hipodens yang sangat luas, biasanya akibat oklusi A. carotis interna atau A. cerebri media proksimal

Infark MultipleInfark baru : batas tidak tegas (umbra dan penumbra)Infark lama : batas tegas krn sudah ada liquefaksi parenkim otak ensefalomalasia

Corpus AlienumBenda asing : logam, pasir, batu, kayuLogam : beam hardening artefacts spt sinar yang mengarah radier dgn pusat pada corpus alienum

Hydrocephalus Hydrocephalus, a problem with the ratio of production of CSF to its reabsorbtion, is most frequent in children. Communicating hydrocephalus is the most common and is due to arachnoid villi and subarachnoid space obstruction. Obstructive hydrocephalus is less common but may occur as a result of the following: o Aqueductal stenosis or occlusion o Trapped fourth ventricle o Ependymitis *

*In these sections from the same patient notice the enlagement of the ventricles and cisterns that occurs with hydrocephalus.

Meningioma Meningiomas are the most common extra-axial neoplasm of the brain. Middle-aged women are most frequently affected. Twenty percent of meningiomas calcify. On CT, meningiomas are usually isointense to gray matter. *

Bone windows confirm calcification within the mass. Axial, post contrast CT demonstrating broad based enhancing extra-axial mass. *

Thank you..

Normal axial head CT images. Appropriate window selection allows visualization of both intracranial contents A and bony calvarium B. Note differences in attenuation between gray matter (right basal ganglia, large arrow), white matter (left internal capsule, small black arrows), cerebrospinal fluid (CSF; frontal horn of the left lateral ventricle, white arrows), and bone (skull, arrowheads). *Cistern : waduk , bak, tangki air************