smacc 2014 presentation
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Who am I?
EmergencyMedicineIreland.com
Come and work •Ultrasound/imaging•Education•Trauma
neuroanatomy for the critically illIm
age
Cre
dit:
brai
n_bl
ogge
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Flic
kr
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e C
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t: A
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ress
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/w
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stra
tion
Brai
n H
erni
atio
n
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SubFalcineTransTentorialTonsillar
1
2
3
Image Credit: Wikipedia
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1. SubFalcine Herniation
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Middle Cerebral Artery
Anterior Cerebral Artery
Posterior Cerebral Artery
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2. TransTentorial Herniation
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Oculomotor Nv
Descending Motor Tracts
2. TransTentorial Herniation
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Med
ulla
Pons
Chiari Malformatio
Tonsillar HerniationConing
3. Tonsillar Herniation
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Hyd
roce
phal
us
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The only way in and out of the ventricular system is through the 4thMedian
Aperture
Lat Aperture
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t: Ps
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1Int
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feat
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rela
ted
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BLOOD
Sup Sag Sinus
Arachnoid Granulation
Why the hydrocephalus?
EmergencyMedicineIreland.comImag
e C
redi
t: R
adio
logy
Sig
ns
http
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subd
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-or-
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adur
al-b
lood
-it-
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Suture
EDH v SDH
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spine
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Three Columns in Spinal Injury
Ant
erio
r
Mid
dle
Post
erio
r
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Imag
e C
redi
t: R
ober
to S
chub
ert
on R
adio
paed
iaht
tp://
radi
opae
dia.
org/
case
s/th
ree-
colu
mn-
conc
ept-
of-t
he-s
pine
Anterior Middle Posterior
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Ant
erio
r Lo
ngit
udin
al L
igam
ent
Post
erio
r Lo
ngit
udin
al L
igam
ent
Liga
men
tum
Fla
va
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Flexion TearDrop Fracture
2 Column Injury
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vascular supply
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Imag
e: R
adsw
iki.n
et
47 year old male•low speed RTA 2 days ago•no injuries of note apart from mild neck pain•now dramatic neck pain and bilateral neuro signs
Vertebral Artery Dissection
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CC License
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EmergencyMedicineIreland.comAtlas (C1 Vertebra)
Vertebral Artery
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Intra-Cranial
Extra-Cranial
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Elastica Externa
Sub Arachnoid Space
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things you read on CT reports but don’t know
what they mean...
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Radiology Report: J Bloggs
There is a large acute SDH and
the basal cisterns are effaced.
Clinical correlation advised...
Happy to discuss... when not browsing BMW magazines...
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Radiology Report: J Bloggs
There is an area of hyperattenuation
in the region of the basal ganglia. It
extends into the internal capsule. The
basal cisterns are patent.
Imag
e C
redi
t: Fr
ank
Gai
llard
on
Rad
iopa
edia
ht
tp://
radi
opae
dia.
org/
case
s/ba
sal-g
angl
ia-
haem
orrh
age-
ct
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Motor Cortex
Nerve Root
Posterior Limb
Anterior Limb
The Internal Capsule
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Striate Arteries
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