Cerebrus

Click "Search" to find an article
MKP TERM SCENARIOS - keywords
watershed injury (parasagittal cerebral injury) border zone ulegyria cognitive dysfunction / CP selective neuronal death in thalamus, striatum and perirolandic cortex dyskinetic CP status marmoratus and pericentral ulegyria spastic quadriplegic CP frontoparietal watershed perirolandic cortex putamen dorsal and lateral thalamus mediodorsal and ventrolateral plus ventroposterior temporal watershed cardiac arrest type of diencephalon - hindbrain injury primary disseminated white matter injury with secondary cell death in thalamus and caudate selective neuronal death in extensive cortical areas with secondary caudate/ thalamic cell death cranial nerve dysfunction cognitive dysfunction extensive white matter thalamus hypothalamus hippocampus colliculi reticular formation and surrounding nuclei dentate and Purkinje cells extensive cortex caudate caudate thalamus selective thalamus selective A B1 ADC map with high contrast selective injury to posterior putamen, day 9 B2 injury to deep grey matter with luxury perfusion, day 3, during cooling C white matter selective damage, day 3; “tramlines” parasagittal high frequency linear probe ACA to MCA watershed injury, day 5 D B3 mastoid view ( coll: su. collateralis OT: sulcus occipitotemporalis) cortical necrosis, day 8 TS OT cerebellum coll hyperechoic change in thalamus and dentate nucleus, day 16 cortex hyperechoic compared to subcortical white matter similar hyperechoic change to cortex B A long standing antepartum global forebrain ischaemia subacute late antepartum global forebrain ischaemia day 5 day 10 day 10 asphyxia hyperechoic thalamus (ventral anterior, lateral and posterior) hyperechoic thalami on day intrapartum antepartum recent antepartum old 1 - - + 3 + - + 7-14 ± + + high signal thalamus (ventral anterior, lateral and posterior) early infantile Leigh phenotype A1 A2 molybdenum cofactor deficiency pyruvate dehydrogenase dificiency B A3 C1 C2 DW MRI end of day 2 all major arteries patent at the time of MR examination term infant with prolonged hyperstimulation of the uterus traction on falx by vacuum traction above fontanelle injury to bone and underlying tissue 1 repeated compression and release of pressure on skull and neck 2 fetus subgaleal haemorrhage and cephalhaematoma 3 4 uncal herniation Uterus uterus Cord cord dehiscence at lambdoid suture involving superior sagittal sinus crowning head Crowning head fundal pressure (vis à tergo) release of all pressure impression of occipital squame general small vessel compression by high ICP temporal lobe haematoma and transverse sinus thrombosis arterial spasm lesions under the cup arterial embolism/ dystocia strain on dural membranes traction/rotation arterial injury direct arterial injury 1 2 3 4 focal compression by forceps blades subgaleal space epidural space subdural space subpial/subarachnoid space stem and cord laceration external pressure on the cranium pressure depends on: duration of external pressure, magnitude of pressure, area size and site (vertex less affected than equatorial plane) typical moulding aggravated by vacuum extraction = parietal lift above frontal and occipital bones inferior sagittal sinus moulding falx straight sinus internal cerebral vein GCV basal vein of Rosenthal tentorium great cerebral vein = GCV rise in intracranial pressure the free tentorial margin ruptures by excessive traction-compression; deep veins are distended (congested) decelerations of the fetal heart changes in fetal EEG pattern similar to effects of hypoxia A term, occiput anterior location, secondary caesarean with difficult retrieval of the head superior frontal gyrus in parasagittal section, day 2 second week cavitation parasagittal detail B term, failed vacuum extraction, secondary caesarean, no clinical seizures, day 2 coronal high frequency detail: hyperechoic core of superior frontal gyrus T2 MRI SWI SSS patency at posterior fontanel ADC map DW MRI A1 A2 anterior fontanel mastoid fontanel term, vaginal breech delivery hyperechoic change in inferior cerebellar hemispheres B lateral X ray sagittal scan, high contrast term, spontaneous vaginal delivery, apnoeic seizures day 1: partial thrombosis in the ipsilateral transverse sinus A1 A2 DWMRI T2MRI B C limited flow in partially thrombosed left TS flow only in right TS temporal lesion pointing in direction of the transverse sinus phase-contrast MRV A B C 5 basal subdural haematoma posterior interhemispheric subdural haematoma 2 1 3 4 3 pericerebellar subdural haematoma limited central tentorial haematoma mastoid view SSS 4 n te ria to a re la term, precipitate delivery, apnoea day 1, von Willebrand disease D normal sagittal section 2 cerebrum 1 cerebellum term vaginal breech delivery term, outlet vacuum extensive centrotentorial subdural haematoma 1 35w GA, grunting after vacuum delivery extensive intracerebellar haematoma A B C anterior fontanel window before puncture thalamic (embolic ?) stroke CST PCA uncus SCA after puncture tentorium pial PCA stroke Kernohan’s notch herniation of the uncus temporalis unilateral mydriasis - ptosis - ipsilateral paresis (contralateral corticospinal tract CST compressed at Kernohan’s notch) - tense fontanelle - posterior fontanel window postsurgical MRI right axial view D peritentorial subdural haematoma, extending to parietal lobe PCA pial stroke right PCA no longer occluded on admission A extensive left intracerebellar haematoma B ventricular dilatation due to posterior fossa crowding lateral ventricle drainage D extensive brain ischaemia due to upward herniation C ACA ICA reversed diastolic flow in investigated cerebral arteries MCA R DWMR after ventricular drainage: bright brain < extensive cortical and deep grey matter necrosis meningitis (sub)cortical infarction pia abscess formation periventricular venous infarction bacteria and neutrophils begin an inflammatory infiltrate meningitis septal empyema first day granuloma cortex ventriculitis lethargy within 48h hydrocephalus infiltrate spreads intima proliferates encephalitis arterial stroke Y Y Y Y Y Y Y seizures focal nerve palsies day 3-7 Y further intimal reaction with fibrosis Y Y Y Y cortical protein exudate (fibrinogen, antibodies) and oedema Y Y restored vessel residual tissue loss pia-arachnoid adhesions complex growing infiltrate with lymfocytes and histiocytes Y week 2 - ... Y IL1, TNF hydrocephalus loculated exudate (empyema) vessel occlusion with (sub)cortical infarction microglial and astroglial response in cortex A mycoplasma meningitis sagittal axial T2 MRI temporal lobe and ventricle brainstem enlarged pericerebellar space B late onset GBS meningitis in 4 different infants frontal coronal enlarged extracerebral spaces above meningeal thickening coronal views at the foramen of Monro courtesy dr Horsch, Berlin day 27 day 20 A coronal day 34 coronal coronal sepsis-meningitis 15 days after preterm birth at 27w GA; all cultures negative coronal detail parasagittal collapsed pallium cerebellum v3 @ mastoid B preterm, listeria sepsis and meningitis day 19 parasagittal A C Rickham reservoir staphylococcal infection globular exudate (->) with later strand formation E Coli strands reservoir removed reservoir trajectory after removal B klebsiella encephalitis and ventriculitis at term matrix infection intraventricular strands strands MRI at 5 months hyperechoic ependyma A late onset GBS meningitis B preterm IVH plus E Coli meningitis mastoid view hyperechoic ependyma mild asymmetry in coronal views C term, late onset GBS meningitis lateral to the cerebellum: collection of pus and blood ? A B klebsiella sepsis and meningiitis several early abscesses in formation C near term preterm, serratia in skin cultures cerebellar abscess with stafylococcus aureus A B term, day 2, early onset GBS meningitis term, late onset GBS meningitis term, shock, PPHN, E Coli urosepsis 7 left striatal perforator stroke multiple arterial strokes C D early onset GBS meningitis: hypothalamic and striatal perforator strokes E Coli septic shock anterior choroidal artery stroke chiasm MCA A early onset GBS encephalitis T2 MRI diffusion weighted MRI B listeria encephalitis ADC map secondary thalamic neuronal necrosis primary white matter disease early cyst formation, serial scan A day 33 B diffusion weighted MRI in the acute phase day 38 MCA (middle cerebral artery) MCA M1 distal, sparing striatum MCA ACA PCA MCA complete (M1 proximal) ACA (anterior cerebral artery) MCA anterior trunk PCA (posterior cerebral artery) MCA operculofrontal artery MCA posterior trunk A differential ADC drop in thalamus versus striatum and cortex acute hyperechoic asymmetry patent MCA MR day 2 CUS day 3 B D CUS day 5 CUS day 6 MCA operculofrontal a. stroke C CUS day 4 left posterior truncal MCA stroke MR day 3 bilateral MCA stroke with patent major arteries A second week CUS Heubner’s a. area spared left distal pure pial ACA stroke (not affecting Heubner’s artery) day 30 MRI B DWI right PCA pial stroke ? the posterior fontanel window T1 flair 1L 2R 1. within the left central groove 3R 4. in the right precentral gyrus (at hand knob) 4R 5R 2. around the right inferior central groove 5. in the right inferior precentral gyrus 6L 3. in the right central groove central artery perfusion area 6. in the left inferior precentral gyrus B A T2 CUS day 1 SWAN bilateral thalamic haemorrhage MR day 2 MRV deep vein congestion leading to haemorrhage in thalami and white matter T1 ICVs enlarged partially thrombosed GCV ICV doppler pattern partial great cerebral vein thrombosis