SlideShare ist ein Scribd-Unternehmen logo
1 von 85
Downloaden Sie, um offline zu lesen
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
www.freelivedoctor.com
www.freelivedoctor.com
-  maternal folic acid deficiency -  other potential associated  malformations include: 1. Arnold-Chiari Syndrome 2. Hydrocephalus 3.  hydromyelia 4.  polymicrogyria b)  Anencephaly i)  congenital absence of part or all  brain ii)  is second in incidence to spina  bifida iii)  concurrent with spina bifida www.freelivedoctor.com
www.freelivedoctor.com
www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
www.freelivedoctor.com
c)  Syringomyelia i)  tubular cavitation (syrinx) which  extends for variable distances along  entire length of spinal cord -  may or may not communicate  with central canal ii)  usually encountered in adults -  many cases thought to  represent congenital  malformation iii)  causes relate to trauma,  ischemia,tumors iv)  motor and sensory deficits   anatomical location in spinal cord www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
i)  may occur when meningomyelocele  anchors lower end of spinal cord -  causes downward growth of  spinal cord and -  creates traction on medulla ii)  curvature of medulla iii)  breaking of quadringeminal plate iv)     intracranial pressure associated  with hydrocephalus f)  Pathology: i)  caudal aspect of cerebellar vermis  is herniated through an enlarged  foramen magnum www.freelivedoctor.com
www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
www.freelivedoctor.com
c)  lissencephaly i)  cortical surfaces are smooth or  imperfectly formed gyri d)  heterotopias i)  focal defects that lead to  modules of ectopic neurons ii)  mental retardation iii)  may be caused by maternal  alcoholism www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
c)  Trisomy 13-15 i)  Holoprosencephaly -  microcephalic brain -  absence of corpus collusum -  absence of interhemispheric  fissure -  rarely compatible with life  beyond a few weeks ii)  arhinencepahaly -  absence of olfactory tracts  and bulbs (rhinencephalon) -  associated with  holoprosencephaly or as solitary  lesion www.freelivedoctor.com
www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
-  may be associated with  compression of branches of the  anterior cerebral artery ii)  transtentorial (uncinate)  herniation -  medial aspects of temporal  lobe is compressed against  tentorium cerebelli -  3 rd  cranial nerve is  compressed -  pupillary dilation and ocular  movement impairment on side of  lesion www.freelivedoctor.com
-  progression of this type of  herniation    hemorrhages in  pons and midbrain (Duret  hemorrhages) -  may result from the tearing of  penetrating veins and arteries  supplying upper brainstem iii)  tonsilar herniation -  displacement of cerebellum  (tonsils) through foramen magnum -  this type of herniation is life  threatening ( compression of  brainstem - - CV and resp centers)  www.freelivedoctor.com
www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
b)  middle meningeal arteries occupy space  between dura and calvaria  i)  grooved into inner table of bone ii)  branches across temporal-parietal  area (mainly as 3 major vessels) c)  temporal bone one of thinnest bones of  skull i)  vulnerable to fractures -  minor trauma may cause  fracture -  and transect branches of  middle meningeal artery    life  threatening epidural  hemorrhage www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
www.freelivedoctor.com
-  venous sinuses are compressed     cerebral ischemia (hypoxia)   -  diffuse cortical impairment     confusion and disorientation d)  ”Cushing Reflex” is protective response  to    CBF and oxygenation i)  HR    (increases filling) ii)  myocardial contractility   iii)  systolic BP   e)  hematoma can    to ~60 ml i)  after compensation is exhausted   ii)  brain shifted laterally away from  side of hematoma www.freelivedoctor.com
iii)  medial temporal lobe compressed  against midbrain    displaces it     through in tentorium    fatal event  known as “transtentorial herniation” iv)  3rd nerve compression v)  pupil fixed and dilated (same side) vi)  further compression    further  hypoxia and impairs neuronal function vii)  damage to reticular formation     expressed clinically as decline in level  of consciousness www.freelivedoctor.com
viii)  shortly thereafter     hemorrhage and necrosis of  brainstem    irreversible damage     death or irreversible coma f)  epidural hematomas are progressive  and if not treated, are fatal in ~4-48 hrs g)  concussion i)  transient loss of consciousness due  to trauma ii)  mainly to brainstems reticular  formation -  e.g., boxing “knock-out”   -  deflects head up and  posteriorly   www.freelivedoctor.com
-  these motions import quick  torque on brainstem and cause    functional paralysis of  neurons of reticular formation iii)  a blow to temporal-parietal area may  cause skull fracture but does  NOT   generally cause a concussion -  lateral movement of cerebral  hemispheres is prevented by the  Falx www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
b)  when brain impacts skull i)  stationary head struck  ii)  moving head strikes object c)  cause shearing effect in subdural space i)  tears veins  d)  unlike epidural space, subdural space  can expand i)  since bleeding usually is from veins ii)  usually stops spontaneously (i.e.,  bleeding) -  with only ~ 25-50 ml -  from local tamponade effect e)  can compress veins    thrombosis f)  usually bilateral  www.freelivedoctor.com
www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
www.freelivedoctor.com
i)  may be reabsorbed    only small  amounts of residual hemosiderin ii)  remain static with potential for     calcification iii)  hemorrhage may enlarge  (rebleeding, usually within 6 months) iv)  granulation tissue is vulnerable to  re-bleed (shaking of head) c)  during genesis of subdural hematoma i)  bridging vein severance is precisely  located to the subdural space -  compartmentalizes blood away  from CSF www.freelivedoctor.com
-  absence of blood in CSF does  NOT  negate presence of subdural  hematoma d)  clinical S & S: i)  stretching meninges    headache ii)  pressure on motor cortex     contralateral weakness iii)  focal cortical irritation     seizures iv)  bilateral subdural hematoma     cognitive dysfunction -  misdiagnose as dementia v)  rebleeding may cause  transtentorial herniation www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
a)  high velocity i)  disrupts tissue by its own mass ii)  centrifugal blast -  enlarges diameter of cylinder  causing disruption iii)  can cause immediate death -  explosive    in ICP, which   -  herniates cerebellar tonsils  into foramen magnum d)  seizures are a threat in healed  penetrating wounds i)  6-12 months after the trauma www.freelivedoctor.com
www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
c)  hyperflexion injury i)  head or shoulders hit from behind -  head driven forward  -  sharp forward angulation of  spinal cord d)  consequences of spinal cord injury vary i)  concussion -  mildest injury -  transient and reversible of  spinal cord function ii)  contusion -  more severe trauma ranging  from    (minor transient bruise    hemorrhage) www.freelivedoctor.com
www.freelivedoctor.com
-  spinal cord necrosis and edema  caused by contusion     myelomalacia  hematoma within cord    hematomyelia iii)  lacerations and transactions -  usually produced by  penetrating wounds -  are irreversible -  cause paralysis of lower limbs  (paraplegia) -  or quadriplegia (all 4  extemitites  www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
www.freelivedoctor.com
www.freelivedoctor.com
d)  bacterial infections i)  leads to mycotic aneurysms e)  trauma i)  rarely caused dissecting aneurysms 1.  Berry aneurysm a)  consequence of arterial defects b)  arise during embryogenesis i)  when arteries bifurcate c)  greater than 90% of sacular aneurysms  occur at branch points in carotid system d)  rupture results in life-threatening SAH i)  ~35% mortality during initial  hemorrhage www.freelivedoctor.com
www.freelivedoctor.com
2. Atherosclerotic  aneurysm a)  localized mainly in major cerebral  arteries i)  vertebral ii)  basilar iii)  internal carotid b)  fibrous replacement of media and  c)  destruction of internal elastic  membrane i)  weakens arterial wall    aneurysm d)  they are fusiform and elongate e)  rarely rupture i) major complication is thrombosis www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
i)  occurs in preferential sites (order  of frequency) -  basal ganglia-thalamus (65%) -  pons (15%) -  cerebellum (8%) -  Other causes of cerebral hemorrhage, independent of hypertension: AVM leakage, erosion of blood vessel by neoplasm, bleeding diathesis – (e.g., thrombocytopenic purpura), endothelial injury via microorganisms (e.g., ricketisiae), embolic infarction (hemorrhage into area of necrosis) www.freelivedoctor.com
d)  compromises integrity of arterial wall  by depositing i)  lipid ii)  hyaline material (i.e., protein) iii)  i and ii known as  “lipohyalinosis ” iv)  weakening wall leads to Charcot- Bouchard aneurysm -  located mainly along trunk of a  blood vessel rather than at its  bifurcation e)  onset of symptoms is abrupt i)  weakness usually dominates  www.freelivedoctor.com
www.freelivedoctor.com
ii)  when hemorrhage is progressive -  death within hours to days -  as hematoma enlarges, may  cause death via transtentorial  herniation -  may rupture into ventricle  with massive hemorrhage     distension of 4th ventricle and  compression of vital centers -  Routine hemorrhage     catastrophic    loss of  consciousness    damage to  reticular formation – death  prior to arriving at hospital www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
1. Global Ischemia a)  pattern of injury reflects anatomy of  cerebral vasculature i)   Watershed infarcts: anterior, middle and posterior  cerebral arteries perfuse overlapping  territories -  no anastamoses between their  terminal branches -  areas of overlap are therefore  not perfused as well and  infarcts (via global ischemia)  occur in these “watershed  areas” www.freelivedoctor.com
ii)   Laminar necrosis : also reflects  topography of cerebral  vasculature -  intraparenchymal pial vessels -  penetrate at right angles and  are deep penetrators into  grey matter -  more focal areas of ischemia  iii)   Selective neuronal sensitivity -  Purkinje cells of cerebellum -  pyramidal neurons of Sommer  sector I hippocampus www.freelivedoctor.com
www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
e)  clinical outcome dependent on  structures involved i)  proximal and MCA occluded by  atherosclerosis and thrombosis -  resultant infarct transects  internal capsule    hemiparesis  or hemiplegia f)  localized ischemia associated with 3  distinct clinical syndromes i)  TIA (transient ischemic attack) -  focal cerebral dysfunction last  less than 24 hrs (usually only a  few minutes in duration) -  signifies risk for infarct www.freelivedoctor.com
ii)  stroke in evolution -  progression of neurological  symptoms while patient is under  observation -  uncommon and usually reflects  propagation of a thrombus in  carotid or basilar artery  iii)  complete stroke -  stable neurologic defects  resulting from cerebral infarct www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
www.freelivedoctor.com
-  occlusion of carotid artery  produce infarcts (most often) to  portions of distribution of the  MCA b)  Circle of Willis i)  deficits depend on collateral  circulation ii)  MCA often occluded by  thrombosis complicating  atherosclerosis in circle of Willis www.freelivedoctor.com
c)  Parenchymal arteries and arterioles i)  rarely become atherosclerotic ii)  damaged by hypertension iii)  small lacunar infarcts iv)  when occur in    numbers -  multiple infarct dementia v)  fibronoid necrosis (hypertensive  encephalopathy) via malignant  hypertension -  minute hemorrhages  (petechiae)  www.freelivedoctor.com
d)  capillary bed i)  small emboli (fat or air) occlude  capillary bed -  petechiae most common in  white matter  e)  cerebral veins i)  venous sinus thrombosis is  potentially lethal for the following: -  systemic dehydration (e.g.,  infants with g.i. fluid loss) -  phlebitis (mastoiditis or  bacteremia) -  obstruction by neoplasm -  sickle cell disease www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com
[object Object],[object Object],[object Object],[object Object],www.freelivedoctor.com

Weitere ähnliche Inhalte

Was ist angesagt?

Cerebellum & ataxia
Cerebellum & ataxiaCerebellum & ataxia
Cerebellum & ataxiaAmr Hassan
 
Cns cong anomalies
Cns cong anomaliesCns cong anomalies
Cns cong anomaliesMed Study
 
Congenital malformation of cns
Congenital malformation of cnsCongenital malformation of cns
Congenital malformation of cnsPS Deb
 
Neural tube defects a case series - copy
Neural tube defects   a case series - copyNeural tube defects   a case series - copy
Neural tube defects a case series - copyULTRAFEST
 
Cortical dysplasia and epilepsy
Cortical dysplasia and epilepsyCortical dysplasia and epilepsy
Cortical dysplasia and epilepsyDr-Ashraf Abdou
 
Lipomyelocele powerpoint presentation.
Lipomyelocele powerpoint presentation.Lipomyelocele powerpoint presentation.
Lipomyelocele powerpoint presentation.Ritesh Mahajan
 
Embyrogenesis of the CNS and its disorders
Embyrogenesis of the CNS and its disordersEmbyrogenesis of the CNS and its disorders
Embyrogenesis of the CNS and its disordersAmr Hassan
 
Spinal dysraphism
Spinal dysraphismSpinal dysraphism
Spinal dysraphismairwave12
 
Presentation1.pptx. radiological imaging of epilepsy.
Presentation1.pptx. radiological imaging of epilepsy.Presentation1.pptx. radiological imaging of epilepsy.
Presentation1.pptx. radiological imaging of epilepsy.Abdellah Nazeer
 
Basics of Neuroradiology
Basics of NeuroradiologyBasics of Neuroradiology
Basics of NeuroradiologyAmr Hassan
 
Chiari malformation
Chiari malformationChiari malformation
Chiari malformationSourabh Jain
 
Spinal dysraphism
Spinal dysraphismSpinal dysraphism
Spinal dysraphismViral Patel
 
Imaging of spinal dysraphism
Imaging of spinal dysraphismImaging of spinal dysraphism
Imaging of spinal dysraphismMuthu Magesh
 
Spinal dysraphism
Spinal dysraphismSpinal dysraphism
Spinal dysraphismnagabalu3
 
Disorders of neural tube closure and neuronal migration
Disorders of neural tube closure and neuronal migrationDisorders of neural tube closure and neuronal migration
Disorders of neural tube closure and neuronal migrationdrnaveent
 
Congenital malformations of the skull
Congenital malformations of the skullCongenital malformations of the skull
Congenital malformations of the skullAhmed Koriesh
 
Imaging in spinal dysraphism
Imaging in spinal dysraphismImaging in spinal dysraphism
Imaging in spinal dysraphismPooja Saji
 

Was ist angesagt? (20)

Cerebellum & ataxia
Cerebellum & ataxiaCerebellum & ataxia
Cerebellum & ataxia
 
Neurorad 2
Neurorad 2Neurorad 2
Neurorad 2
 
Cns cong anomalies
Cns cong anomaliesCns cong anomalies
Cns cong anomalies
 
Congenital malformation of cns
Congenital malformation of cnsCongenital malformation of cns
Congenital malformation of cns
 
Neural tube defects a case series - copy
Neural tube defects   a case series - copyNeural tube defects   a case series - copy
Neural tube defects a case series - copy
 
Cortical dysplasia and epilepsy
Cortical dysplasia and epilepsyCortical dysplasia and epilepsy
Cortical dysplasia and epilepsy
 
Lipomyelocele powerpoint presentation.
Lipomyelocele powerpoint presentation.Lipomyelocele powerpoint presentation.
Lipomyelocele powerpoint presentation.
 
Embyrogenesis of the CNS and its disorders
Embyrogenesis of the CNS and its disordersEmbyrogenesis of the CNS and its disorders
Embyrogenesis of the CNS and its disorders
 
Spinal dysraphism
Spinal dysraphismSpinal dysraphism
Spinal dysraphism
 
Presentation1.pptx. radiological imaging of epilepsy.
Presentation1.pptx. radiological imaging of epilepsy.Presentation1.pptx. radiological imaging of epilepsy.
Presentation1.pptx. radiological imaging of epilepsy.
 
Basics of Neuroradiology
Basics of NeuroradiologyBasics of Neuroradiology
Basics of Neuroradiology
 
Chiari malformation
Chiari malformationChiari malformation
Chiari malformation
 
Spina bifida
Spina bifidaSpina bifida
Spina bifida
 
Spinal dysraphism
Spinal dysraphismSpinal dysraphism
Spinal dysraphism
 
Imaging of spinal dysraphism
Imaging of spinal dysraphismImaging of spinal dysraphism
Imaging of spinal dysraphism
 
Spinal dysraphism
Spinal dysraphismSpinal dysraphism
Spinal dysraphism
 
Disorders of neural tube closure and neuronal migration
Disorders of neural tube closure and neuronal migrationDisorders of neural tube closure and neuronal migration
Disorders of neural tube closure and neuronal migration
 
Congenital malformations of the skull
Congenital malformations of the skullCongenital malformations of the skull
Congenital malformations of the skull
 
Spinal dysraphism
Spinal dysraphismSpinal dysraphism
Spinal dysraphism
 
Imaging in spinal dysraphism
Imaging in spinal dysraphismImaging in spinal dysraphism
Imaging in spinal dysraphism
 

Andere mochten auch

Cns development
Cns developmentCns development
Cns developmentMed Study
 
Neuronal and glial differentiation of human pluripotent stem cells
Neuronal and glial differentiation of human pluripotent stem cellsNeuronal and glial differentiation of human pluripotent stem cells
Neuronal and glial differentiation of human pluripotent stem cellsDiana Santos
 
Traumatic Brain Injury in the United States
Traumatic Brain Injury in the United StatesTraumatic Brain Injury in the United States
Traumatic Brain Injury in the United StatesMary Kneiser
 
Lecture9 cns
Lecture9 cnsLecture9 cns
Lecture9 cnsReach Na
 
Developmental disease of spinal cord
Developmental disease of spinal cordDevelopmental disease of spinal cord
Developmental disease of spinal cordAndrea R Salins
 
Nervous System Introduction and Central Nervous System
Nervous System Introduction and Central Nervous SystemNervous System Introduction and Central Nervous System
Nervous System Introduction and Central Nervous SystemRHSHealthScience
 
Neurologic Trauma ( Injuries )
Neurologic Trauma ( Injuries )Neurologic Trauma ( Injuries )
Neurologic Trauma ( Injuries )mycomic
 
~Bn05 cns forebrain anatomy
~Bn05 cns forebrain anatomy~Bn05 cns forebrain anatomy
~Bn05 cns forebrain anatomyStudent
 
Neuronal stem cellfi
Neuronal stem cellfiNeuronal stem cellfi
Neuronal stem cellfiDUVASU
 
Cns Anatomy Slides
Cns Anatomy SlidesCns Anatomy Slides
Cns Anatomy Slidesguest11eb343
 
Central Nervous System
Central Nervous SystemCentral Nervous System
Central Nervous SystemKevin Young
 
Pathology of cns
Pathology of cnsPathology of cns
Pathology of cnsNailaawal
 
Embryology development of central nervous system
Embryology   development of central nervous systemEmbryology   development of central nervous system
Embryology development of central nervous systemMBBS IMS MSU
 
Traumatic Brain Injuries: Pathophysiology, Treatment and Prevention
Traumatic Brain Injuries: Pathophysiology, Treatment and PreventionTraumatic Brain Injuries: Pathophysiology, Treatment and Prevention
Traumatic Brain Injuries: Pathophysiology, Treatment and PreventionMedicineAndHealthNeurolog
 
Introduction to nervous system
Introduction to nervous systemIntroduction to nervous system
Introduction to nervous systemStephanie Kennedy
 
Traumatic Brain Injury Power Point
Traumatic Brain Injury Power PointTraumatic Brain Injury Power Point
Traumatic Brain Injury Power Pointctrythall
 
Central Nervous System 1
Central Nervous System 1Central Nervous System 1
Central Nervous System 1MBBS IMS MSU
 
Central Nervous System.ppt
Central Nervous System.pptCentral Nervous System.ppt
Central Nervous System.pptShama
 

Andere mochten auch (20)

Cns development
Cns developmentCns development
Cns development
 
CNS Development
CNS DevelopmentCNS Development
CNS Development
 
Neuronal and glial differentiation of human pluripotent stem cells
Neuronal and glial differentiation of human pluripotent stem cellsNeuronal and glial differentiation of human pluripotent stem cells
Neuronal and glial differentiation of human pluripotent stem cells
 
Carcdio ppt
Carcdio pptCarcdio ppt
Carcdio ppt
 
Traumatic Brain Injury in the United States
Traumatic Brain Injury in the United StatesTraumatic Brain Injury in the United States
Traumatic Brain Injury in the United States
 
Lecture9 cns
Lecture9 cnsLecture9 cns
Lecture9 cns
 
Developmental disease of spinal cord
Developmental disease of spinal cordDevelopmental disease of spinal cord
Developmental disease of spinal cord
 
Nervous System Introduction and Central Nervous System
Nervous System Introduction and Central Nervous SystemNervous System Introduction and Central Nervous System
Nervous System Introduction and Central Nervous System
 
Neurologic Trauma ( Injuries )
Neurologic Trauma ( Injuries )Neurologic Trauma ( Injuries )
Neurologic Trauma ( Injuries )
 
~Bn05 cns forebrain anatomy
~Bn05 cns forebrain anatomy~Bn05 cns forebrain anatomy
~Bn05 cns forebrain anatomy
 
Neuronal stem cellfi
Neuronal stem cellfiNeuronal stem cellfi
Neuronal stem cellfi
 
Cns Anatomy Slides
Cns Anatomy SlidesCns Anatomy Slides
Cns Anatomy Slides
 
Central Nervous System
Central Nervous SystemCentral Nervous System
Central Nervous System
 
Pathology of cns
Pathology of cnsPathology of cns
Pathology of cns
 
Embryology development of central nervous system
Embryology   development of central nervous systemEmbryology   development of central nervous system
Embryology development of central nervous system
 
Traumatic Brain Injuries: Pathophysiology, Treatment and Prevention
Traumatic Brain Injuries: Pathophysiology, Treatment and PreventionTraumatic Brain Injuries: Pathophysiology, Treatment and Prevention
Traumatic Brain Injuries: Pathophysiology, Treatment and Prevention
 
Introduction to nervous system
Introduction to nervous systemIntroduction to nervous system
Introduction to nervous system
 
Traumatic Brain Injury Power Point
Traumatic Brain Injury Power PointTraumatic Brain Injury Power Point
Traumatic Brain Injury Power Point
 
Central Nervous System 1
Central Nervous System 1Central Nervous System 1
Central Nervous System 1
 
Central Nervous System.ppt
Central Nervous System.pptCentral Nervous System.ppt
Central Nervous System.ppt
 

Ähnlich wie Cns path congenital, edema

Cns infections
Cns infectionsCns infections
Cns infectionsraj kumar
 
Cns degeneration, demyelination and tumors
Cns degeneration, demyelination and tumorsCns degeneration, demyelination and tumors
Cns degeneration, demyelination and tumorsraj kumar
 
hydrocephalus and csf disorders powerpoint
hydrocephalus and csf disorders powerpointhydrocephalus and csf disorders powerpoint
hydrocephalus and csf disorders powerpointrohanjohnjacob
 
Valvular heart disease
Valvular heart diseaseValvular heart disease
Valvular heart diseaseraj kumar
 
Diagnostic Imaging of Congenital Central Nervous System Diseases
Diagnostic Imaging of Congenital Central Nervous System DiseasesDiagnostic Imaging of Congenital Central Nervous System Diseases
Diagnostic Imaging of Congenital Central Nervous System DiseasesMohamed M.A. Zaitoun
 
Radiological findings of congenital anomalies of the spine and spinal cord
Radiological findings of congenital anomalies of the spine and spinal cordRadiological findings of congenital anomalies of the spine and spinal cord
Radiological findings of congenital anomalies of the spine and spinal cordDr. Armaan Singh
 
Presentation1.pptx, radiological imaging of congenital anomalies of the spine...
Presentation1.pptx, radiological imaging of congenital anomalies of the spine...Presentation1.pptx, radiological imaging of congenital anomalies of the spine...
Presentation1.pptx, radiological imaging of congenital anomalies of the spine...Abdellah Nazeer
 
NECK anatomy muscles with clinical anatomy.pdf
NECK  anatomy muscles with clinical anatomy.pdfNECK  anatomy muscles with clinical anatomy.pdf
NECK anatomy muscles with clinical anatomy.pdfsiddhimeena3
 
Imaging of congenital anomalies of spine and spinal cord
Imaging of congenital  anomalies of spine and spinal cord Imaging of congenital  anomalies of spine and spinal cord
Imaging of congenital anomalies of spine and spinal cord charusmita chaudhary
 
Neuronal migration disorders
Neuronal migration disordersNeuronal migration disorders
Neuronal migration disordersAmr Hassan
 
Hydrocephalus in neonate
Hydrocephalus in neonateHydrocephalus in neonate
Hydrocephalus in neonateHesham Shapan
 
Spaces of head and neck and infections /certified fixed orthodontic courses b...
Spaces of head and neck and infections /certified fixed orthodontic courses b...Spaces of head and neck and infections /certified fixed orthodontic courses b...
Spaces of head and neck and infections /certified fixed orthodontic courses b...Indian dental academy
 
Spaces of head&neck &infections /certified fixed orthodontic courses by India...
Spaces of head&neck &infections /certified fixed orthodontic courses by India...Spaces of head&neck &infections /certified fixed orthodontic courses by India...
Spaces of head&neck &infections /certified fixed orthodontic courses by India...Indian dental academy
 
INTRACRANIAL COMPLICATIONS OF CSOM
INTRACRANIAL COMPLICATIONS OF CSOMINTRACRANIAL COMPLICATIONS OF CSOM
INTRACRANIAL COMPLICATIONS OF CSOMDr Harjitpal Singh
 
MRI Of White matter.ppt
MRI Of White matter.pptMRI Of White matter.ppt
MRI Of White matter.pptQasedKareem
 
Anatomy of the Scalp
Anatomy of the ScalpAnatomy of the Scalp
Anatomy of the ScalpRafid Rashid
 

Ähnlich wie Cns path congenital, edema (20)

Cns infections
Cns infectionsCns infections
Cns infections
 
Cns degeneration, demyelination and tumors
Cns degeneration, demyelination and tumorsCns degeneration, demyelination and tumors
Cns degeneration, demyelination and tumors
 
hydrocephalus and csf disorders powerpoint
hydrocephalus and csf disorders powerpointhydrocephalus and csf disorders powerpoint
hydrocephalus and csf disorders powerpoint
 
Valvular heart disease
Valvular heart diseaseValvular heart disease
Valvular heart disease
 
Head trauma
Head traumaHead trauma
Head trauma
 
Diagnostic Imaging of Congenital Central Nervous System Diseases
Diagnostic Imaging of Congenital Central Nervous System DiseasesDiagnostic Imaging of Congenital Central Nervous System Diseases
Diagnostic Imaging of Congenital Central Nervous System Diseases
 
Radiological findings of congenital anomalies of the spine and spinal cord
Radiological findings of congenital anomalies of the spine and spinal cordRadiological findings of congenital anomalies of the spine and spinal cord
Radiological findings of congenital anomalies of the spine and spinal cord
 
Hydrocephalus project
Hydrocephalus projectHydrocephalus project
Hydrocephalus project
 
Presentation1.pptx, radiological imaging of congenital anomalies of the spine...
Presentation1.pptx, radiological imaging of congenital anomalies of the spine...Presentation1.pptx, radiological imaging of congenital anomalies of the spine...
Presentation1.pptx, radiological imaging of congenital anomalies of the spine...
 
NECK anatomy muscles with clinical anatomy.pdf
NECK  anatomy muscles with clinical anatomy.pdfNECK  anatomy muscles with clinical anatomy.pdf
NECK anatomy muscles with clinical anatomy.pdf
 
Imaging of congenital anomalies of spine and spinal cord
Imaging of congenital  anomalies of spine and spinal cord Imaging of congenital  anomalies of spine and spinal cord
Imaging of congenital anomalies of spine and spinal cord
 
Neuronal migration disorders
Neuronal migration disordersNeuronal migration disorders
Neuronal migration disorders
 
Hydrocephalus in neonate
Hydrocephalus in neonateHydrocephalus in neonate
Hydrocephalus in neonate
 
Spaces of head and neck and infections /certified fixed orthodontic courses b...
Spaces of head and neck and infections /certified fixed orthodontic courses b...Spaces of head and neck and infections /certified fixed orthodontic courses b...
Spaces of head and neck and infections /certified fixed orthodontic courses b...
 
Spaces of head&neck &infections /certified fixed orthodontic courses by India...
Spaces of head&neck &infections /certified fixed orthodontic courses by India...Spaces of head&neck &infections /certified fixed orthodontic courses by India...
Spaces of head&neck &infections /certified fixed orthodontic courses by India...
 
Hydrocephalus
Hydrocephalus   Hydrocephalus
Hydrocephalus
 
Acute brain
Acute brainAcute brain
Acute brain
 
INTRACRANIAL COMPLICATIONS OF CSOM
INTRACRANIAL COMPLICATIONS OF CSOMINTRACRANIAL COMPLICATIONS OF CSOM
INTRACRANIAL COMPLICATIONS OF CSOM
 
MRI Of White matter.ppt
MRI Of White matter.pptMRI Of White matter.ppt
MRI Of White matter.ppt
 
Anatomy of the Scalp
Anatomy of the ScalpAnatomy of the Scalp
Anatomy of the Scalp
 

Mehr von raj kumar

The umbilical cord
The umbilical cordThe umbilical cord
The umbilical cordraj kumar
 
The placenta
The placentaThe placenta
The placentaraj kumar
 
The foetal membranes
The foetal membranesThe foetal membranes
The foetal membranesraj kumar
 
Physiology of reproduction
Physiology of reproductionPhysiology of reproduction
Physiology of reproductionraj kumar
 
Minor complaints during pregnancy
Minor complaints during pregnancyMinor complaints during pregnancy
Minor complaints during pregnancyraj kumar
 
Diagnosis of pregnancy
Diagnosis of pregnancyDiagnosis of pregnancy
Diagnosis of pregnancyraj kumar
 
Antenatal care
Antenatal careAntenatal care
Antenatal careraj kumar
 
Postpartum mood disorders
Postpartum mood disordersPostpartum mood disorders
Postpartum mood disordersraj kumar
 
Normal and abnormal puerperium
Normal and abnormal puerperiumNormal and abnormal puerperium
Normal and abnormal puerperiumraj kumar
 
Vacuum extraction (ventouse)
Vacuum extraction (ventouse)Vacuum extraction (ventouse)
Vacuum extraction (ventouse)raj kumar
 
Symphysiotomy
SymphysiotomySymphysiotomy
Symphysiotomyraj kumar
 
Forceps delivery
Forceps deliveryForceps delivery
Forceps deliveryraj kumar
 
Caesarean section
Caesarean sectionCaesarean section
Caesarean sectionraj kumar
 
Normal labour
Normal labourNormal labour
Normal labourraj kumar
 
Anatomy of the foetal skull
Anatomy of the foetal skullAnatomy of the foetal skull
Anatomy of the foetal skullraj kumar
 
Anatomy of the female pelvis
Anatomy of the female pelvisAnatomy of the female pelvis
Anatomy of the female pelvisraj kumar
 
Active management of normal labour
Active management of normal labourActive management of normal labour
Active management of normal labourraj kumar
 
Thyrotoxicosis in pregnancy
Thyrotoxicosis in pregnancyThyrotoxicosis in pregnancy
Thyrotoxicosis in pregnancyraj kumar
 

Mehr von raj kumar (20)

The umbilical cord
The umbilical cordThe umbilical cord
The umbilical cord
 
The placenta
The placentaThe placenta
The placenta
 
The foetal membranes
The foetal membranesThe foetal membranes
The foetal membranes
 
Physiology of reproduction
Physiology of reproductionPhysiology of reproduction
Physiology of reproduction
 
Minor complaints during pregnancy
Minor complaints during pregnancyMinor complaints during pregnancy
Minor complaints during pregnancy
 
Diagnosis of pregnancy
Diagnosis of pregnancyDiagnosis of pregnancy
Diagnosis of pregnancy
 
Antenatal care
Antenatal careAntenatal care
Antenatal care
 
Postpartum mood disorders
Postpartum mood disordersPostpartum mood disorders
Postpartum mood disorders
 
Normal and abnormal puerperium
Normal and abnormal puerperiumNormal and abnormal puerperium
Normal and abnormal puerperium
 
Version
VersionVersion
Version
 
Vacuum extraction (ventouse)
Vacuum extraction (ventouse)Vacuum extraction (ventouse)
Vacuum extraction (ventouse)
 
Symphysiotomy
SymphysiotomySymphysiotomy
Symphysiotomy
 
Forceps delivery
Forceps deliveryForceps delivery
Forceps delivery
 
Episiotomy
EpisiotomyEpisiotomy
Episiotomy
 
Caesarean section
Caesarean sectionCaesarean section
Caesarean section
 
Normal labour
Normal labourNormal labour
Normal labour
 
Anatomy of the foetal skull
Anatomy of the foetal skullAnatomy of the foetal skull
Anatomy of the foetal skull
 
Anatomy of the female pelvis
Anatomy of the female pelvisAnatomy of the female pelvis
Anatomy of the female pelvis
 
Active management of normal labour
Active management of normal labourActive management of normal labour
Active management of normal labour
 
Thyrotoxicosis in pregnancy
Thyrotoxicosis in pregnancyThyrotoxicosis in pregnancy
Thyrotoxicosis in pregnancy
 

Cns path congenital, edema

  • 1.
  • 2.
  • 4.
  • 7. - maternal folic acid deficiency - other potential associated malformations include: 1. Arnold-Chiari Syndrome 2. Hydrocephalus 3. hydromyelia 4. polymicrogyria b) Anencephaly i) congenital absence of part or all brain ii) is second in incidence to spina bifida iii) concurrent with spina bifida www.freelivedoctor.com
  • 10.
  • 12. c) Syringomyelia i) tubular cavitation (syrinx) which extends for variable distances along entire length of spinal cord - may or may not communicate with central canal ii) usually encountered in adults - many cases thought to represent congenital malformation iii) causes relate to trauma, ischemia,tumors iv) motor and sensory deficits anatomical location in spinal cord www.freelivedoctor.com
  • 13.
  • 14. i) may occur when meningomyelocele anchors lower end of spinal cord - causes downward growth of spinal cord and - creates traction on medulla ii) curvature of medulla iii) breaking of quadringeminal plate iv)  intracranial pressure associated with hydrocephalus f) Pathology: i) caudal aspect of cerebellar vermis is herniated through an enlarged foramen magnum www.freelivedoctor.com
  • 16.
  • 17.
  • 18.
  • 19.
  • 21. c) lissencephaly i) cortical surfaces are smooth or imperfectly formed gyri d) heterotopias i) focal defects that lead to modules of ectopic neurons ii) mental retardation iii) may be caused by maternal alcoholism www.freelivedoctor.com
  • 22.
  • 23. c) Trisomy 13-15 i) Holoprosencephaly - microcephalic brain - absence of corpus collusum - absence of interhemispheric fissure - rarely compatible with life beyond a few weeks ii) arhinencepahaly - absence of olfactory tracts and bulbs (rhinencephalon) - associated with holoprosencephaly or as solitary lesion www.freelivedoctor.com
  • 25.
  • 26.
  • 27. - may be associated with compression of branches of the anterior cerebral artery ii) transtentorial (uncinate) herniation - medial aspects of temporal lobe is compressed against tentorium cerebelli - 3 rd cranial nerve is compressed - pupillary dilation and ocular movement impairment on side of lesion www.freelivedoctor.com
  • 28. - progression of this type of herniation  hemorrhages in pons and midbrain (Duret hemorrhages) - may result from the tearing of penetrating veins and arteries supplying upper brainstem iii) tonsilar herniation - displacement of cerebellum (tonsils) through foramen magnum - this type of herniation is life threatening ( compression of brainstem - - CV and resp centers) www.freelivedoctor.com
  • 30.
  • 31. b) middle meningeal arteries occupy space between dura and calvaria i) grooved into inner table of bone ii) branches across temporal-parietal area (mainly as 3 major vessels) c) temporal bone one of thinnest bones of skull i) vulnerable to fractures - minor trauma may cause fracture - and transect branches of middle meningeal artery  life threatening epidural hemorrhage www.freelivedoctor.com
  • 32.
  • 34. - venous sinuses are compressed  cerebral ischemia (hypoxia)  - diffuse cortical impairment  confusion and disorientation d) ”Cushing Reflex” is protective response to  CBF and oxygenation i) HR  (increases filling) ii) myocardial contractility  iii) systolic BP  e) hematoma can  to ~60 ml i) after compensation is exhausted  ii) brain shifted laterally away from side of hematoma www.freelivedoctor.com
  • 35. iii) medial temporal lobe compressed against midbrain  displaces it  through in tentorium  fatal event known as “transtentorial herniation” iv) 3rd nerve compression v) pupil fixed and dilated (same side) vi) further compression  further hypoxia and impairs neuronal function vii) damage to reticular formation  expressed clinically as decline in level of consciousness www.freelivedoctor.com
  • 36. viii) shortly thereafter  hemorrhage and necrosis of brainstem  irreversible damage  death or irreversible coma f) epidural hematomas are progressive and if not treated, are fatal in ~4-48 hrs g) concussion i) transient loss of consciousness due to trauma ii) mainly to brainstems reticular formation - e.g., boxing “knock-out”  - deflects head up and posteriorly  www.freelivedoctor.com
  • 37. - these motions import quick torque on brainstem and cause  functional paralysis of neurons of reticular formation iii) a blow to temporal-parietal area may cause skull fracture but does NOT generally cause a concussion - lateral movement of cerebral hemispheres is prevented by the Falx www.freelivedoctor.com
  • 38.
  • 39. b) when brain impacts skull i) stationary head struck ii) moving head strikes object c) cause shearing effect in subdural space i) tears veins d) unlike epidural space, subdural space can expand i) since bleeding usually is from veins ii) usually stops spontaneously (i.e., bleeding) - with only ~ 25-50 ml - from local tamponade effect e) can compress veins  thrombosis f) usually bilateral www.freelivedoctor.com
  • 41.
  • 43. i) may be reabsorbed  only small amounts of residual hemosiderin ii) remain static with potential for  calcification iii) hemorrhage may enlarge (rebleeding, usually within 6 months) iv) granulation tissue is vulnerable to re-bleed (shaking of head) c) during genesis of subdural hematoma i) bridging vein severance is precisely located to the subdural space - compartmentalizes blood away from CSF www.freelivedoctor.com
  • 44. - absence of blood in CSF does NOT negate presence of subdural hematoma d) clinical S & S: i) stretching meninges  headache ii) pressure on motor cortex  contralateral weakness iii) focal cortical irritation  seizures iv) bilateral subdural hematoma  cognitive dysfunction - misdiagnose as dementia v) rebleeding may cause transtentorial herniation www.freelivedoctor.com
  • 45.
  • 46.
  • 48.
  • 49. a) high velocity i) disrupts tissue by its own mass ii) centrifugal blast - enlarges diameter of cylinder causing disruption iii) can cause immediate death - explosive  in ICP, which  - herniates cerebellar tonsils into foramen magnum d) seizures are a threat in healed penetrating wounds i) 6-12 months after the trauma www.freelivedoctor.com
  • 51.
  • 52.
  • 53. c) hyperflexion injury i) head or shoulders hit from behind - head driven forward - sharp forward angulation of spinal cord d) consequences of spinal cord injury vary i) concussion - mildest injury - transient and reversible of spinal cord function ii) contusion - more severe trauma ranging from  (minor transient bruise  hemorrhage) www.freelivedoctor.com
  • 55. - spinal cord necrosis and edema caused by contusion  myelomalacia hematoma within cord  hematomyelia iii) lacerations and transactions - usually produced by penetrating wounds - are irreversible - cause paralysis of lower limbs (paraplegia) - or quadriplegia (all 4 extemitites www.freelivedoctor.com
  • 56.
  • 58.
  • 59.
  • 60.
  • 63. d) bacterial infections i) leads to mycotic aneurysms e) trauma i) rarely caused dissecting aneurysms 1. Berry aneurysm a) consequence of arterial defects b) arise during embryogenesis i) when arteries bifurcate c) greater than 90% of sacular aneurysms occur at branch points in carotid system d) rupture results in life-threatening SAH i) ~35% mortality during initial hemorrhage www.freelivedoctor.com
  • 65. 2. Atherosclerotic aneurysm a) localized mainly in major cerebral arteries i) vertebral ii) basilar iii) internal carotid b) fibrous replacement of media and c) destruction of internal elastic membrane i) weakens arterial wall  aneurysm d) they are fusiform and elongate e) rarely rupture i) major complication is thrombosis www.freelivedoctor.com
  • 66.
  • 67. i) occurs in preferential sites (order of frequency) - basal ganglia-thalamus (65%) - pons (15%) - cerebellum (8%) - Other causes of cerebral hemorrhage, independent of hypertension: AVM leakage, erosion of blood vessel by neoplasm, bleeding diathesis – (e.g., thrombocytopenic purpura), endothelial injury via microorganisms (e.g., ricketisiae), embolic infarction (hemorrhage into area of necrosis) www.freelivedoctor.com
  • 68. d) compromises integrity of arterial wall by depositing i) lipid ii) hyaline material (i.e., protein) iii) i and ii known as “lipohyalinosis ” iv) weakening wall leads to Charcot- Bouchard aneurysm - located mainly along trunk of a blood vessel rather than at its bifurcation e) onset of symptoms is abrupt i) weakness usually dominates www.freelivedoctor.com
  • 70. ii) when hemorrhage is progressive - death within hours to days - as hematoma enlarges, may cause death via transtentorial herniation - may rupture into ventricle with massive hemorrhage  distension of 4th ventricle and compression of vital centers - Routine hemorrhage  catastrophic  loss of consciousness  damage to reticular formation – death prior to arriving at hospital www.freelivedoctor.com
  • 71.
  • 72. 1. Global Ischemia a) pattern of injury reflects anatomy of cerebral vasculature i) Watershed infarcts: anterior, middle and posterior cerebral arteries perfuse overlapping territories - no anastamoses between their terminal branches - areas of overlap are therefore not perfused as well and infarcts (via global ischemia) occur in these “watershed areas” www.freelivedoctor.com
  • 73. ii) Laminar necrosis : also reflects topography of cerebral vasculature - intraparenchymal pial vessels - penetrate at right angles and are deep penetrators into grey matter - more focal areas of ischemia iii) Selective neuronal sensitivity - Purkinje cells of cerebellum - pyramidal neurons of Sommer sector I hippocampus www.freelivedoctor.com
  • 75.
  • 76.
  • 77. e) clinical outcome dependent on structures involved i) proximal and MCA occluded by atherosclerosis and thrombosis - resultant infarct transects internal capsule  hemiparesis or hemiplegia f) localized ischemia associated with 3 distinct clinical syndromes i) TIA (transient ischemic attack) - focal cerebral dysfunction last less than 24 hrs (usually only a few minutes in duration) - signifies risk for infarct www.freelivedoctor.com
  • 78. ii) stroke in evolution - progression of neurological symptoms while patient is under observation - uncommon and usually reflects propagation of a thrombus in carotid or basilar artery iii) complete stroke - stable neurologic defects resulting from cerebral infarct www.freelivedoctor.com
  • 79.
  • 81. - occlusion of carotid artery produce infarcts (most often) to portions of distribution of the MCA b) Circle of Willis i) deficits depend on collateral circulation ii) MCA often occluded by thrombosis complicating atherosclerosis in circle of Willis www.freelivedoctor.com
  • 82. c) Parenchymal arteries and arterioles i) rarely become atherosclerotic ii) damaged by hypertension iii) small lacunar infarcts iv) when occur in  numbers - multiple infarct dementia v) fibronoid necrosis (hypertensive encephalopathy) via malignant hypertension - minute hemorrhages (petechiae) www.freelivedoctor.com
  • 83. d) capillary bed i) small emboli (fat or air) occlude capillary bed - petechiae most common in white matter e) cerebral veins i) venous sinus thrombosis is potentially lethal for the following: - systemic dehydration (e.g., infants with g.i. fluid loss) - phlebitis (mastoiditis or bacteremia) - obstruction by neoplasm - sickle cell disease www.freelivedoctor.com
  • 84.
  • 85.