-
excellent for spinal canal stenosis
CT
-
excellent for tumors, herniated disk and other spinal pathologies - the modality of choice
MRI
-
Most common spinal malformation
Defect of the neural arch that occurs during fetal spinal development - 8-16 weeks
Spina bifida
-
Highest incidence in Welsh and Irish ancestry
Has been linked to deficient levels of folic acid (B vitamin) during pregnancy
Spina bifida
-
Three types of deformities
- spina bifida occulta
- meningocele
- myelomeningocle
-
most common, least serious Location – L4 – L5 or L5 –S1
Incomplete gap in the neural arch or lamina (bony defect) – see p. 98 fi, 4-4
Generally asymptomatic but can be seen radiographically on routine lumbar spine or pelvis views
spina bifida occulta
-
spina bifida with meningeal protusion
meningocele
-
spina bifida with both meninges and spinal cord protusion
myelomeningocle
-
occurs usually as part of the aging process - seen as signs/symptoms of osteoarthritis
can occur anywhere in the spine, although the neck and low back are the most common areas
degenerative joint disease (DJD)
-
radiographic signs include: narrowing of the zygoapophyseal joint spaces
45 degree oblique views best to demonstrate
degenerative joint disease (DJD)
-
occurs usually as part of the aging process - seen as signs/symptoms of osteoarthritis. Neck and low back common locations
radiographic signs include: narrowing of the disk spaces between the vertebral bodies
90 degree lateral view best to demonstrate
degenerative disk disease (DDD)
-
Structural defects
- spondylosis
- spondylolysis
- spondylolisthesis
-
degenerative changes in cervical spine due to structural defects
spondylosis
-
defect in pars articularis (neck of the Scotty dog)
spondylolysis
-
forward displacement of vertebral body because of pars defect
spondylolisthesis
-
occurs when the nucleus pulposus prolaspes either anterior (most common in the cervical region) or posterior into the spinal canal (most common in the lumbar region)
Disk herniation (HNP)
-
symptoms including tingling, numbness, and pain along shoulders/arm or buttocks extending down posterior aspect of leg (this a cardinal sign for a lumbar HNP)
Disk herniation (HNP)
-
can cause nerve damage and muscle atrophy if not treated
radiographic signs include; filling defect of contrast media in spinal canal /nerve rootlets (myelogram) and bulge defect (MRI)
surgery (laminectomy) most frequent treatment but not always successful
Disk herniation (HNP)
-
displacement or asymmetry of lateral ventricles – this is positive for a space occupying lesion – blood, tumor, edema, abscess etc Normal lateral ventricles have a symmetrical “ butterfly shape”
midline shift
-
can not be seen on plain radiographic images
Ventricles
-
CT and MRI are the modalities of choice
skull
-
projection with out rotation is important projection to show asymmetry
PA
-
Excessive accumulation of cerebrospinal fluid within the ventricles
Treatment: ventricular shunt
Hydrocephalus
-
Radiographs for shunt placement must include
both ends of the shunt
-
hydrocephalus can also be seen again as part of
aging
-
sudden interruption of cerebral circulation (ischemia) resulting in a neurological deficit
Acute brain infarct (Stroke or CVA)
-
Three major causes of stroke
Thrombosis - blood clot , common symptom is transient ischemic attacks (TIA)
Embolism - vascular obstruction caused by fat, air, tumor etc that travels to the right atrium Middle cerebral artery most common site for obstructing embolism
Hemorrhage - usually coming from cerebral artery
-
three types of hemorrhage
- epidural
- subdural
- subarachoid
-
arterial bleeding , medial meningeal
epidural
-
venous bleed between dura and meniges
subdural
-
bleeding into the ventricular system
subarachoid
-
abnormal, persistent dilatation of a vessel, usually an artery
Aneurysm
-
most common form is non trauma but developmental
results in abnormal circulatory communication between the arterial and venous vessels in the brain
can cause increased cranial pressure resulting in ruptured blood vessels causing death
Arteriovenous malformation (AVM
-
blow to the head usually not causing loss of conscious brain is bruised
Concussion
-
More serious than concussion because of possible damaged blood vessels resulting in bleeding
CT shows low density areas of edema (darker color) with scattered high density areas of bleeding (lighter color)
Usually loss of conscious
Contusion
-
irregular radiolucent lines without displacement
Linear
-
splintered bone fragments
Commimuted
-
curvilinear or "broken eggshell" appearance, usually the result of blunt trauma
Depressed
-
results from gunshot wound or accident that causes imbedding of foreign objects
Projectile/penetrating
-
the most common complication of skull trauma is
shock
-
Radiographic appearance depends on location of the
tumor and subsequent “mass effect”
-
MRI is the most sensitive modality for identifying
tumors
-
T1 images with contrast best to distinguish
edema/blood from actual tumor
-
meningioma
acoustic neuroma
pituitary adenoma
are?
benign
-
gliomas
glioblastomas
astrocytomas
are?
malignant
-
arises from arachnoid cells and attaches to the dura
meningioma
-
8th cranial nerve
acoustic neuroma
-
anterior lobe of pituitary lobe
pituitary adenoma
-
mainly cerebral
glioblastomas
-
slow growing but malignant
astrocytomas
-
largest group of primary brain tumors, composed of malignant glial cells
gliomas
-
Diagnosis of spine pathologies is best done by
CT MRI
-
Diagnosis of skull pathologies either at the tissue level (involves the brain) or the vascular level is best done by
CT MRI SPECT
-
fluid is dark, tumors gray (low signal)
T1
-
fluid is light, tumors white (high signal)
T2
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