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Bellingham Technical College
        Biology 130

 Sectional Anatomy
     Week 3:
    The Brain


           Instructor: Ken Wilkerson
           E-mail: wilkersk@hotmail.com
Labeling Exercises
• Use your pgdn key to scroll through the
  following scans and try to name the labeled
  anatomy before revealing the answers.
A Clivus



                            B Medulla Oblongata




                              C 4th Ventricle


                            D Cerebellum




MRI WO Contrast T2 Weight
A Middle Cerebral Artery

                             B Posterior Cerebra Artery

                               C Mid-Brain

                                 D Vermis of Cerebellum




MRI WO Contrast T2 Weight
A Ant. Horn of lateral ventricle

                       B Head of caudate nucleus


                       C Thalamus

                       D Post. Horn of lateral Ventricle




CT Brain WO contrast
A. Carotid Artery



                    B. Jugular Vein




            C. Vertebral Arteries


CTA Brain
A. Anterior Cerebral Artery

                                           B. Middle Cerebral Artery

                                           C. Post. Cerebral Artery




CTA Brain Maximum Intensity Projection
Intracranial Hemorrhage
• As an imaging technologist in advanced
  imaging modalities, it is important to
  understand the differences, and recognize the
  physical appearance of different classifications
  of intracranial hemorrhage.
• The following slides will help you recognize
  and identify different types of intracranial
  hemorrhage.
Types of Intracranial Hemorrhage
Intra-axial                         Extra-axial
• intraparenchymal                  • Epidural
   – Bleeding within the brain         – Bleeding that occurs between the
                                         dura and cranial bone.
     tissue.
                                    • Subdural
• Intraventricular                     – Subdural hematoma occurs when
   – Bleeding into the ventricles        there is tearing of the bridging vein
                                         between the cerebral cortex and a
                                         draining venous sinus. At times
                                         they may be caused by arterial
                                         lacerations on the brain surface.
                                    • Subarachnoid
                                       – meningeal layers.occuring between
                                         the arachnoid and pia
Intra-axial

•   intraparenchymal                                       • Intraventricular
                                                              – Intraventricular hemorrhage has
    –   Nontraumatic intraparenchymal hemorrhage                been found to occur in 35% of
        most commonly results from hypertensive                 moderate to severe traumatic brain
        damage to blood vessel walls e.g.: -                    injuries.[11] The injury requires a
         hypertension -eclampsia - drug abuse, but it
        also may be due                                         great deal of force to cause. Thus the
        to autoregulatory dysfunction with excessive            hemorrhage usually does not occur
        cerebral blood flow e.g.: - reperfusion injury -        without extensive associated
        hemorrhagic transformation - cold exposure -            damage, and so the outcome is rarely
        rupture of an aneurysm or arteriovenous
        malformation (AVM) - arteriopathy                       good.[12][13]
        (e.g. cerebral amyloid angiopathy, moyamoya)          – Prognosis is also dismal when IVH
        -                                                       results from intracerebral
        altered hemostasis (e.g. thrombolysis, anticoa
        gulation, bleeding diathesis) - hemorrhagic             hemorrhage related to high blood
        necrosis (e.g.tumor, infection) - venous                pressure and is even worse
        outflow obstruction (e.g. cerebral venous               when hydrocephalus follows.[1] It
        sinus thrombosis). Nonpenetrating and                   can result in dangerous increases
        penetrating cranial trauma can be also
        common causes of intracerebral hemorrhage.              in intracranial pressure and can cause
                                                                potentially fatal brain herniation.[1]
Extra-Axial
• Epidural Hematoma
  – Bleeding between the dura of the brain and the
    inner surface of the cranium.
     • This is a traumatic injury caused by a sharp blow to the
       head. Often this type of hemorrhage will be associated
       with an underlying cranial fracture.
Extra-Axial
• Subdural Hematoma

• Subdural hematomas are usually the result of a serious head injury.
  When one occurs in this way, it is called an "acute" subdural
  hematoma. Acute subdural hematomas are among the deadliest of
  all head injuries. The bleeding fills the brain area very
  rapidly, compressing brain tissue. This often results in brain injury
  and may lead to death.
• Subdural hematomas can also occur after a very minor head
  injury, especially in the elderly. These may go unnoticed for many
  days to weeks, and are called "chronic" subdural hematomas. With
  any subdural hematoma, tiny veins between the surface of the
  brain and its outer covering (the dura) stretch and tear, allowing
  blood to collect. In the elderly, the veins are often already stretched
  because of brain atrophy (shrinkage) and are more easily injured.
Intraparenchymal Hemorrhage
Intraventricular Hemorrhage
Epidural Hemorrhage

          Note convex appearance of hemorrhage
          This is caused by the pressure of the blood
          Pushing against the dural membrane
Subdural Hemorrhage




           Concave, “quarter moon” appearance
           suggesting separation of the surface
           of the brain from the dura.. Also,
           note the appearance of blood in the
           sagittal sinus.
Subarachnoid Hemorrhage


             The presence of blood within the
             Sylvian (lateral) fissures is a clear
             indication of SAH.
Last Slide

          Keep up the good work!

All material in this presentation is testable.

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Week3

  • 1. Bellingham Technical College Biology 130 Sectional Anatomy Week 3: The Brain Instructor: Ken Wilkerson E-mail: wilkersk@hotmail.com
  • 2. Labeling Exercises • Use your pgdn key to scroll through the following scans and try to name the labeled anatomy before revealing the answers.
  • 3. A Clivus B Medulla Oblongata C 4th Ventricle D Cerebellum MRI WO Contrast T2 Weight
  • 4. A Middle Cerebral Artery B Posterior Cerebra Artery C Mid-Brain D Vermis of Cerebellum MRI WO Contrast T2 Weight
  • 5. A Ant. Horn of lateral ventricle B Head of caudate nucleus C Thalamus D Post. Horn of lateral Ventricle CT Brain WO contrast
  • 6. A. Carotid Artery B. Jugular Vein C. Vertebral Arteries CTA Brain
  • 7. A. Anterior Cerebral Artery B. Middle Cerebral Artery C. Post. Cerebral Artery CTA Brain Maximum Intensity Projection
  • 8. Intracranial Hemorrhage • As an imaging technologist in advanced imaging modalities, it is important to understand the differences, and recognize the physical appearance of different classifications of intracranial hemorrhage. • The following slides will help you recognize and identify different types of intracranial hemorrhage.
  • 9. Types of Intracranial Hemorrhage Intra-axial Extra-axial • intraparenchymal • Epidural – Bleeding within the brain – Bleeding that occurs between the dura and cranial bone. tissue. • Subdural • Intraventricular – Subdural hematoma occurs when – Bleeding into the ventricles there is tearing of the bridging vein between the cerebral cortex and a draining venous sinus. At times they may be caused by arterial lacerations on the brain surface. • Subarachnoid – meningeal layers.occuring between the arachnoid and pia
  • 10. Intra-axial • intraparenchymal • Intraventricular – Intraventricular hemorrhage has – Nontraumatic intraparenchymal hemorrhage been found to occur in 35% of most commonly results from hypertensive moderate to severe traumatic brain damage to blood vessel walls e.g.: - injuries.[11] The injury requires a hypertension -eclampsia - drug abuse, but it also may be due great deal of force to cause. Thus the to autoregulatory dysfunction with excessive hemorrhage usually does not occur cerebral blood flow e.g.: - reperfusion injury - without extensive associated hemorrhagic transformation - cold exposure - damage, and so the outcome is rarely rupture of an aneurysm or arteriovenous malformation (AVM) - arteriopathy good.[12][13] (e.g. cerebral amyloid angiopathy, moyamoya) – Prognosis is also dismal when IVH - results from intracerebral altered hemostasis (e.g. thrombolysis, anticoa gulation, bleeding diathesis) - hemorrhagic hemorrhage related to high blood necrosis (e.g.tumor, infection) - venous pressure and is even worse outflow obstruction (e.g. cerebral venous when hydrocephalus follows.[1] It sinus thrombosis). Nonpenetrating and can result in dangerous increases penetrating cranial trauma can be also common causes of intracerebral hemorrhage. in intracranial pressure and can cause potentially fatal brain herniation.[1]
  • 11. Extra-Axial • Epidural Hematoma – Bleeding between the dura of the brain and the inner surface of the cranium. • This is a traumatic injury caused by a sharp blow to the head. Often this type of hemorrhage will be associated with an underlying cranial fracture.
  • 12. Extra-Axial • Subdural Hematoma • Subdural hematomas are usually the result of a serious head injury. When one occurs in this way, it is called an "acute" subdural hematoma. Acute subdural hematomas are among the deadliest of all head injuries. The bleeding fills the brain area very rapidly, compressing brain tissue. This often results in brain injury and may lead to death. • Subdural hematomas can also occur after a very minor head injury, especially in the elderly. These may go unnoticed for many days to weeks, and are called "chronic" subdural hematomas. With any subdural hematoma, tiny veins between the surface of the brain and its outer covering (the dura) stretch and tear, allowing blood to collect. In the elderly, the veins are often already stretched because of brain atrophy (shrinkage) and are more easily injured.
  • 15. Epidural Hemorrhage Note convex appearance of hemorrhage This is caused by the pressure of the blood Pushing against the dural membrane
  • 16. Subdural Hemorrhage Concave, “quarter moon” appearance suggesting separation of the surface of the brain from the dura.. Also, note the appearance of blood in the sagittal sinus.
  • 17. Subarachnoid Hemorrhage The presence of blood within the Sylvian (lateral) fissures is a clear indication of SAH.
  • 18. Last Slide Keep up the good work! All material in this presentation is testable.