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Slide 1 Computed Tomography (CT): A “simplified” Topographical review of the Brain Jon Wheiler, ACNP - BC ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 2 Tomography vs Topography Tomography: A technique for displaying a representation of a cross section through a human body or other solid object using X - rays or ultrasound: Topography: A detailed description or representation on a map of the natural and artificial features of an area: ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 3 Learning Objective To reinforce and expand your knowledge base regarding computed tomography and brain anatomy whereby enhancing your function as a Healthcare provider. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________

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Slide 1

Computed Tomography (CT):

A “simplified” Topographical review

of the Brain

Jon Wheiler, ACNP-BC

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Slide 2 Tomography vs Topography

Tomography:

• A technique for displaying a

representation of a cross

section through a human

body or other solid object

using X-rays or ultrasound:

Topography:

• A detailed description or

representation on a map of

the natural and artificial

features of an area:

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Slide 3 Learning Objective

To reinforce and expand your knowledge base

regarding computed tomography and brain

anatomy whereby enhancing your function as a

Healthcare provider.

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Slide 4

Disclosure:

I am not a Radiologist, Neuroradiologist,

Neurologist, Neurointensivist, or

Neurosurgeon:

I have no financial affiliation with any

commercial supporters of this conference:

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Slide 5 Outline

Computed Tomography Design and Function

Neuroanatomy

Head CT Mapping

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Slide 6

Computed Tomography Basics

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Slide 7 Computed Tomography (CT) Physics

Physics of CT simplified:

– CT is comprised of a rotating Xray source and detector

– The X-rays are absorbed in varying degrees by different tissues

– A computer assigns numerical numbers based on tissue density

– Hounsfield Units (HUs) : Sir Godfrey Newbold Hounsfield

HU Table:

– Air -1000

– Water 0

– Bone +1000

– Anatomy

– Windowing:– Center – HU value

– Width - +/-

– Numerical Values based on density

Substance HUs

Air -1000

Fat -120

Water 0

Muscle +40

Bone +400

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Slide 8 Pneumocephalus

Cerebral Spinal

Fluid

Brain Tissue:

Gray & White

Matter

Bone

Blood

EVD

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Slide 9 Computed Tomography Scan

The images generated are generally in

the axial or transverse plane,

modern scanners allow this

volume of data to be reformatted

in various planes or even as

volumetric (3D) representations of

structures.

– Axial

– Sagittal

– Coronal

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Slide 10 Computed Tomography Brain: Uses

Uses:

– Blood (Intracranial hemorrhage, Trauma, Cerebral Edema)

– Ischemia (Stroke, Trauma, Encephalopathy)

– Enlarged Ventricles (Hydrocephalus, Trauma, ICH)

– Foreign Objects (Trauma, GSW, Diseases)

– Brain Mass/Lesion

– Diseases or malformations of the cerebral

vasculature, brain tissue, and/or skull

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Slide 11 Brain Terminology

Gyrus - a convoluted ridge between anatomical grooves

Cerebri:- two folds of Dura mater separating the hemispheres of the brain (falx cerebri)

Cerebral Cortex: brain matter differentiated into gray and white matter characteristically connected by different layers and neuronal types

Sulcus - a shallow furrow on the surface of the brain separating adjacent convolutions

Fissure - any of the deep clefts of the brain ; (Lateral [Sylvian] fissure)

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Slide 12 Brain Terminology

Cistern – widened subarachnoid spaces/reservoir for storing CSF: usually found at the base of the brain

Sinuses – a dilated channels found between layers of Dura mater in the brain for venous blood flow.

Meninges: Dura – Arachnoid – Pia matter. The system of membranes which envelops the central nervous system. The dura being the outermost, thickest layer.

Tentorium cerebelli - an arched fold of dura mater forming a partition between the cerebrum and cerebellum:

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Slide 13 Brain Terminology

Choroid Plexus - is the area on the ventricles of the brain where cerebrospinal fluid is produced by modified ependymal cells.

Ventricular System - A system of communicating cavities in the brain that are continuous with the central canal of the spinal cord providing a pathway for CSF

Ganglia: the "basal ganglia" is a group of nuclei interconnected with the cerebral cortex, thalamus and brainstem

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Slide 14 Brain Terminology

Insula –(Insular Cortex) considered the 5th lobe of the cortex which separates the temporal lobe the parietal lobe dorsally.

Hemisphere – left and right: Dominant vs Nondominant

Lobes – purely anatomical classification of areas of the brain related to different brain functions. Frontal lobe, Parietal lobe, Temporal lobe, Occipital lobe, Insula, and Cerebellum.

Regions – Functional and cognitive areas of the brain as related to function: Sensorimotor Area, Hindbrain, Midbrain, Forebrain, & Neural pathways.

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Slide 15 Anatomical Terminology

Posterior – Toward the back – situated behind; dorsal.

Anterior – Before or in front of – the abdominal side of the body.

Dorsal – going from the belly to the spinal column.

Ventral – going from the spinal column to the belly.

Caudal – Inferior in position – towards the tail.

Cephalad – Superior in position –towards the head/top.

Inferior – Beneath – below – the undersurface.

Superior – Higher than – Situated above.

Medial – Pertaining to the middle – Nearer the medial plane.

Lateral – Pertaining to the side – away from the mid-plane.

Proximal/Distal - from tip of an appendage (distal) to where it joins the body (proximal).

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Slide 16 The Homunculus

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Slide 17 The Homunculus

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Slide 18

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Slide 19 “Your View” via Head CT

LR

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Slide 20 Axial View of the Brain

Right Left

Foramen

Magnum

Spinal

Cord

Nasopharynx

Maxillary

Sinus

Mandible

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Slide 21 Axial View of the Brain

Occipital

Bone

Sphenoid

Bone

Zygomatic

Arch/Bone

Cisterna

Magna

Medulla

Oblongata

Maxilla

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Slide 22 Axial View of the Brain

(R) Vertebral

Artery

Cerebellum

4th

Ventricle

External

Acoustic Meatus

Nasal

Septum

Cerebellar

Tonsil

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Slide 23 Axial View of the Brain

Fourth

Ventricle

Medulla

oblongata Basilar

Artery

Posterior

Inferior lobe

cerebellum

Mastoid Air

Cells

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Slide 24 Axial View of the Brain

Cerebellum

Pons/Cerebral

Peduncles

Cerebellopontine

cistern

Basilar

Artery

Cerebellar

VermisExternal

Auditory

Canal

Cerebellar

Tonsil

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Slide 25 Axial View of the Brain

Occipital Bone

Pons

(Metencephalon)

Global

Socket

Cerebellar

Hemisphere

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Slide 26 Axial View of the Brain

Frontal Tip

Temporal

Lobe

4th

Ventricle

Suprasellar

CisternTemporal

Bone

Ear

Tentorium

Cerebelli

Eye Orbits

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Slide 27 Axial View of the Brain

Basilar

Artery

Temporal

Lobe

Cerebellopontine

Cistern

Occipital Lobe

Globes

Cerebellum

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Slide 28 Axial View of the Brain

Tentorium

Cerebelli

Pons

Temporal

Lobe

Eyeball

Lateral Rectus

Muscle

Lens

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Slide 29 Axial View of the Brain

Temporal Pole

Lateral ventricle

Basilar

Artery Medial Temporal

Lobes

Occipital

Lobe

Cerebral

Peduncles

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Slide 30 Axial View of the Brain

Hippocampus

Temporal Pole of

Lateral Ventricle

Frontal

Sinus

Optic Tract

Sylvian

Fissure

Uncus

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Slide 31 Axial View of the Brain

Pons/ Cerebral

Peduncles

Midbrain

Cingulate

GyrusTemporal Horns of

the Lateral

Ventricles

Hippocampus

Gyrus rectus:

Base of the

Frontal Lobe

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Slide 32 Axial View of the Brain

Transverse/Superior

Sagittal Sinus

Lateral Ventricles

Third

Ventricle

Amygdala

Lateral

Fissure

(Sylvian)

Temporal

Lobe

Falx Cerebri

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Slide 33 Axial View of the Brain

General area of Tentorium of Cerebellum

Thalamic

Region

Third

Ventricle

Putamen

Choroid

Plexus

Orbitofrontal

Cortex

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Slide 34 Axial View of the Brain

Calcified

Choroid Plexus

Gyrus

Thalamic

Region

Third

Ventricle

Frontal Pole of

Lateral

VentricleCistern Sylvian

Fissure

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Slide 35 Axial View of the Brain

Thalamic

Region

Columns of

Fornix

Posterior Pole

of Lateral

Ventricle

Caudate

Head

Frontal Pole of

Later Ventricle

Splenum of

Corpus

Callosum

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Slide 36 Axial View of the Brain

Broca's

Area

Choroid

Plexus

Thalamic

Region

Anterior limb of

internal capsule

Frontal Horn

of lateral

Ventricle

Posterior limb

of internal

capsule

Wernicke’s

Area

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Slide 37 Axial View of the Brain

Superior

Sagittal

Sinus

Septum

Parietal

Lobe

Body of

Lateral

Ventricles

Frontal

Lobe

Insular

Cortex

Occipital

Lobe

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Slide 38 Axial View of the Brain

Falx

Cerebri

Corpus

callosum

Precentral

Gyrus

Central

Sulcus

Postcentral

Gyrus

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Slide 39 Axial View of the Brain

Frontal lobes

Parietal Lobe

Temporal lobe

Occipital Lobe

Central

sulcus

Cingulate

sulcus

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Slide 40 Axial View of the Brain

Central

Sulcus

Postcentral

Gyrus

Occipital

Gyrus

Precentral Gyrus

Occipital Bone

Superior

Sagittal Sinus

Lateral

Ventricle body

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Slide 41 Axial View of the Brain

Central

Sulcus

Superior sagittal sinus

Superior Frontal Gyrus

Post central

Gyrus

Precentral

GyrusIntraparietal

Sulcus

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Slide 42 Axial View of the Brain

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Slide 43 Axial View of the Brain

Post central sulcus

Superior Frontal Sulcus

Precentral gyrus

Post central gyrus

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Slide 44 Axial View of the Brain

Central sulcus

Posterior margin of the Frontal Lobe

Anterior margin of the Parietal lobe

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Slide 45 Axial View of the Brain

Falx Cerebri

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Slide 46 Axial View of the Brain

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Slide 47 Axial View of the Brain

Superior Sagittal Sinus

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Slide 48 Axial View of the Brain

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Slide 49 Head CT: Bone View

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Slide 50

The End

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