CH 4 central nervous system

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speedyvincent
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208423
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CH 4 central nervous system
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2013-03-19 23:34:09
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  1. excellent for spinal canal stenosis
    CT
  2. excellent for tumors, herniated disk and other spinal pathologies - the modality of choice
    MRI
  3. Most common spinal malformation

    Defect of the neural arch that occurs during fetal spinal development - 8-16 weeks
    Spina bifida
  4. Highest incidence in Welsh and Irish ancestry

    Has been linked to deficient levels of folic acid (B vitamin) during pregnancy
    Spina bifida
  5. Three types of deformities
    • spina bifida occulta
    • meningocele
    • myelomeningocle
  6. most common, least serious Location – L4 – L5 or L5 –S1

    Incomplete gap in the neural arch or lamina (bony defect) – see p. 98 fi, 4-4

    Generally asymptomatic but can be seen radiographically on routine lumbar spine or pelvis views
    spina bifida occulta
  7. spina bifida with meningeal protusion
    meningocele
  8. spina bifida with both meninges and spinal cord protusion
    myelomeningocle
  9. occurs usually as part of the aging process - seen as signs/symptoms of osteoarthritis

    can occur anywhere in the spine, although the neck and low back are the most common areas
    degenerative joint disease (DJD)
  10. radiographic signs include: narrowing of the zygoapophyseal joint spaces

    45 degree oblique views best to demonstrate
    degenerative joint disease (DJD)
  11. occurs usually as part of the aging process - seen as signs/symptoms of osteoarthritis. Neck and low back common locations

    radiographic signs include: narrowing of the disk spaces between the vertebral bodies

    90 degree lateral view best to demonstrate
    degenerative disk disease (DDD)
  12. Structural defects
    • spondylosis
    • spondylolysis
    • spondylolisthesis
  13. degenerative changes in cervical spine due to structural defects
    spondylosis
  14. defect in pars articularis (neck of the Scotty dog)
    spondylolysis
  15. forward displacement of vertebral body because of pars defect
    spondylolisthesis
  16. occurs when the nucleus pulposus prolaspes either anterior (most common in the cervical region) or posterior into the spinal canal (most common in the lumbar region)
    Disk herniation (HNP)
  17. symptoms including tingling, numbness, and pain along shoulders/arm or buttocks extending down posterior aspect of leg (this a cardinal sign for a lumbar HNP)
    Disk herniation (HNP)
  18. can cause nerve damage and muscle atrophy if not treated

    radiographic signs include; filling defect of contrast media in spinal canal /nerve rootlets (myelogram) and bulge defect (MRI)

    surgery (laminectomy) most frequent treatment but not always successful
    Disk herniation (HNP)
  19. displacement or asymmetry of lateral ventricles – this is positive for a space occupying lesion – blood, tumor, edema, abscess etc Normal lateral ventricles have a symmetrical “ butterfly shape”
    midline shift
  20. can not be seen on plain radiographic images
    Ventricles
  21. CT and MRI are the modalities of choice
    skull
  22. projection with out rotation is important projection to show asymmetry
    PA
  23. Excessive accumulation of cerebrospinal fluid within the ventricles

    Treatment: ventricular shunt
    Hydrocephalus
  24. Radiographs for shunt placement must include
    both ends of the shunt
  25. hydrocephalus can also be seen again as part of
    aging
  26. sudden interruption of cerebral circulation (ischemia) resulting in a neurological deficit
    Acute brain infarct (Stroke or CVA)
  27. Three major causes of stroke
    Thrombosis - blood clot , common symptom is transient ischemic attacks (TIA)

    Embolism - vascular obstruction caused by fat, air, tumor etc that travels to the right atrium  Middle cerebral artery most common site for obstructing embolism

    Hemorrhage - usually coming from cerebral artery
  28. three types of hemorrhage
    • epidural
    • subdural
    • subarachoid
  29. arterial bleeding , medial meningeal
    epidural
  30. venous bleed between dura and meniges
    subdural
  31. bleeding into the ventricular system
    subarachoid
  32. abnormal, persistent dilatation of a vessel, usually an artery
    Aneurysm
  33. most common form is non trauma but developmental

    results in abnormal circulatory communication between the arterial and venous vessels in the brain

    can cause increased cranial pressure resulting in ruptured blood vessels causing death
    Arteriovenous malformation (AVM
  34. blow to the head usually not causing loss of conscious brain is bruised
    Concussion
  35. More serious than concussion because of possible damaged blood vessels resulting in bleeding

    CT shows low density areas of edema (darker color) with scattered high density areas of bleeding (lighter color)

    Usually loss of conscious
    Contusion
  36. irregular radiolucent lines without displacement
    Linear
  37. splintered bone fragments
    Commimuted
  38. curvilinear or "broken eggshell" appearance, usually the result of blunt trauma
    Depressed
  39. results from gunshot wound or accident that causes imbedding of foreign objects
    Projectile/penetrating
  40. the most common complication of skull trauma is
    shock
  41. Radiographic appearance depends on location of the
    tumor and subsequent “mass effect”
  42. MRI is the most sensitive modality for identifying
    tumors
  43. T1 images with contrast best to distinguish
    edema/blood from actual tumor
  44. meningioma
    acoustic neuroma
    pituitary adenoma

    are?
    benign
  45. gliomas
    glioblastomas
    astrocytomas

    are?
    malignant
  46. arises from arachnoid cells and attaches to the dura
    meningioma
  47. 8th cranial nerve
    acoustic neuroma
  48. anterior lobe of pituitary lobe
    pituitary adenoma
  49. mainly cerebral
    glioblastomas
  50. slow growing but malignant
    astrocytomas
  51. largest group of primary brain tumors, composed of malignant glial cells
    gliomas
  52. Diagnosis of spine pathologies is best done by
    CT MRI
  53. Diagnosis of skull pathologies either at the tissue level (involves the brain) or the vascular level is best done by
    CT MRI SPECT
  54. fluid is dark, tumors gray (low signal)
    T1
  55. fluid is light, tumors white (high signal)
    T2

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