Embedded Files
BRAIN LATERALIZATION
BRAIN LATERALIZATION
Differential Dx
Differential Dx
Vascular
Infection
Trauma
Autoimmune
Metablolic
Idiopathic
Neoplastic
Congenital
Imaging? CT or MRI
Imaging? CT or MRI
How will the test help you to:
Make a diagnosis
Narrow a clinical differential diagnosis
Rule out Something Bad
CT: Acute Setting, Hemorrhage
MRI: Characterize an abnormality initially seen or occult on CT; problem solving
Head CT Search Patterns
Head CT Search Patterns
Click on the Image to view in Pacsbin
Click on the Image to view in Pacsbin
Find the following:
Find the following:
Lobes: Frontal, Parietal, Occipital, Temporal
Basal Ganglia and Thalamus
Pituitary and Pineal Gland
Brainstem: Midbrain, Pons, Medulla
Middle Cerebral A., Basilar A, Sagittal Sinus
Identify the 3rd Ventricle: Measure the HU in the ventricle
Look at the bone window images and identify the Maxillary sinus: What HU measured in sinus?
Search Patterns: Outside In
Search Patterns: Outside In
Superficial soft tissues
Bones
Sinuses and Mastoid Air Cells
Orbits
Extra-axial spaces-- subarachnoid, subdural and epidural space
Ventricles: too large, mass effect?
Brain Parenchyma-- Mass effect, blurring of gray white? vasogenic edema
General Pre-Work
General Pre-Work
Normal anatomy on Head CT
Terminology used to describe findings on CT
If you are unfamiliar with how to use PACS viewer, watch this short video by my colleague Dr. Michael Hartung.
Click on the image to view in Pacsbin
Click on the image to view in Pacsbin
70 year old male who was brought in by EMS who presents with acute right upper and lower extremity weakness and a headache. The symptoms began 2 hours prior to presentation.
Differential Diagnosis?Localize the lesion?Treatment Decisions?
61 year old, found down, last known well 30 hours prior to presentation. Altered mental status with word finding difficulty.
Localize the lesion?
40 year old male with HTN and diabetes presents to an outside hospital with acute left upper>lower extremity weakness and neglect. Symptoms began 1.5 hours prior to presentation
Localize the lesion?
Patient presents with acute right sided weakness - no aphasia, intact sensory
Localize the lesion?
45 year old with acute onset of symptoms while taking out groceries from her car. Symptoms included numbness involving the right side of her body, weakness of her right upper extremity. Her husband noticed that her speech also did not make any sense. The words were spoken clearly, but the content did not make any sense. She presents to the ER and her symptoms have improved. By the time you exam the patient, she has a normal neuro exam.
What should we do? Is there a role for imaging?
65 year old with pancreatic cancer, acute onset left sided weakness, neglect, right sided gaze deviation. Last known well, 1 hour prior to presentation
Localize the lesion?
52 year old with acute onset of headaches x 2 days with gradual worsening, now with left sided numbness and mild weakness
Localize the lesion?
59 year old with acute onset of right sided weakness and sensory deficits, eye deviation to the right.
Localize the lesion?
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