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8/10/2019 (radiology) RADIOLOGI.ppt
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NEUROPSYCHIATRY
Dr. Muh. Ilyas, Sp.Rad
DEPARTEMENT OF RADIOLOGY
MEDICAL FACULTY
HASASUDDIN UNIVERSITY
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Introduction
Radiologic modality for detected the abnormalityin Neuropsiciatry are :
Plain foto of the skull
CTscan MRI
Ultrasonography (Intracranial Doppler)
Angiography
Myelography
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Introduction
Indication for radiology examination in
Neuropsychiatry diseases :
Chronic Cephalgia
Vertigo
Occult edema pupil or combination
Dysartr
Visus Defect and memory problem
Epilepsy
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SKULL PLAIN FOTO
Some intracranial defect cannot detected withthis examination
Routine position AP & Lateral
Skulll foto can give information about :- The shape & the size of the calvaria
- Calcification, erosion or local sclerotic.
- Shape & size of sella turcica
- Suture
- Vascularisation
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Skull foto, lateral position :Normal
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Skull Foto AP/lat : Normal Calsification
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The Abnormality
Increase of intracranial pressure make thecalvaria change
- dyastasis (find in children )
- Erosion of dorsum sella
- Local erosion or local hyperostosis
- Impressio digitatae (thumb printing)
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Primer tumor
The characteristic of primer tumor in skull photoare
Abnormal Calcification
Local erosion/sclerotic
Erosion of Sella turcica
Dilatation of the vein that effected by abnormal
vascularisation of the tumor. Displacement of glandula pinealis.
Sign of increase intracranial pressure
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Lateral skull Foto : Increase ofintracranial pressure
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Skull foto (AP) : Astrocytoma
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Metastatic Tumor
Multiple coin lesion appeareance
Sign of Increase intracranial pressure
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Hydrocephalus
Radiology finding in skull photo are :
Change of shape & size of the skull
Suture Dyastasis
Erosion of the calvaria
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Skull foto AP/Lat : Hydrocephalus
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Brain CT Scan
The Lesion density divided by :
High density (hyperdens) if the density
of the lesion is more than the normal brain Isodensity if the density of the lesion is
same with the normal brain.
Low density (hypodens) if the densityof the lesion is lower than the normalbrain.
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Abnormality that can find inHead CT Scan :
Brain Tumor
Abnormality in cerebrovasculer
Anomali Infection diseases
Cerebral atrophy/degenerative
diseases
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CT Scan Finding of the Brain tumor :
Mass Effect (sign of emphasis,
displacement and obstruction ) Perifocal Edema
Calcification
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a. b.
Meningitis Tuberkulosa : a. CT, b. MRI
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ENCHEPHALITIS
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Cerebrovasculer Abnormality
cerebrovasculer Abnormality is consisted of :
Intracerebral Hemorragic hypertension
InfarkAneurysm
Arteriovenous malformation
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Miliary Tuberculosis
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Tuberculoma
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Alzheimers Disease
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Encephalitis : a. CT non contast, b. CT contrast
a. b.
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Intracerebral Hemorragic ByHipertension
Caused by ruptured of microaneurysmaarteriole.
In acute fase the blood density is hyperdensor isodens, oval/irrreguler.
The lesion is surrounded by perifocal edema,sometimes with mass effect (compression orherniation).
In Chronic fase the density of the hematoma
is isodens or hypodens , the ventricle syst. andthe sulci dilated caused of atrophy
CT + contras homogen enhancement or ringenhancement.
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Left Intracerebri Hemorragic & Bilateral
Intraventricular Hemorragic
CLINIC: LEFT LATERALISATION EC HS
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CLINIC : TRAUMA CAPITIS (GCS = 9)
SUBDURAL HEMATOMA with SUB FALK HERNIATION
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KLINIS : KESADARAN MENURUN
PERDARAHAN SUBARACNOID,
INTRAVENTRIKULAR BILATERAL DAN PON
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Infark cerebri
Happen by occlusion of cerebral vein thatmake necrotic of the brain.
Necrotic/ischemic of the brain caused by :
- Thrombosis- Emboli
In acute stage usually there is no
abnormality in ct scan.After 4 days There is hypodens area,
rounded/oval/irreguler.
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Infark Cerebri
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KLINIS : KESADARAN MENURUN
INFARK CEREBRI KANAN
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Infark Haemorrhagic : a. CT, b. MRI T1Wi
a. b.
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Aneurysm
Angiography is the best modality fordiagnose because aneurysm is a vascularabnormality.
CT Scan good for detected the
complication of aneurysm ,like :Intracerebral hematoma, infark & edema
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Coronal
Axial
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Arteriovenous Malformation
AVM blood flow from artery to venouswithout passing the capillary.
In CT without contras
there iscalcification, sometimes hyperdenslesion and hydrocephalus.
CT scan + contrast
there is tubularenhancement/tortuous.
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Central Nerve System Anomaly
CNS Anomaly :
Congenital Hydrocephalus
Agenesis Corpus Callosum Sturge-weber synd.
Sclerosis tuberous (Bournevillediseases)
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Congenital Hydrocephalus
Caused of aquaduct stenosis or stenosis osfomanen magendi & Luscka and anomaly offossa posterior structure.
CT scan dilated of ventricle lateralis & 3rdventricle in aquaduct stenosis but the 4thventricle still normal.
Dandy Walker synd dilated of ventricle
lateralis , 3rdventricle & 4thventricle.
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Hydrocephalus
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Hydrocephalus
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KLINIS ; HIDROCHEPHALUS
HYDRANENCHEPALY
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Agenesis Corpus Callosum
Caused of corpus callosum not growth ,maybe caused by a trauma in firstsemester of the pregnancy.
CT scan finding agenesis of corpuscallosum, agenesis septum pellucidum,with position of 3rdventricle is higher ,
the right & left lateral ventricle areseparate.
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Cerebral Abcess
Caused by sprending infection of otitismedia/ mastoiditis.
soliter or multiple
CT scan finding hypodens area in thecortex or corticomedullar junction
CT + contras ring enhancement
surrounding the hypodens area. There isperifocal edema out of the ringenhancment .
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a. b.
Abces Cerebri : a. CT non contrast, b. CT contrast
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Cerebral atrophy
CT scan finding The space betweentabula interna & the outer margin of the
cortex cerebri more wider.Sulci, Silvii fissure & cistern basalis arewider too.
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Atrofi Cerebri
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M R I
One of Radiology modality produced picture of human body scan
without X ray but used magnetic.
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1. Isointens
2. Hypointens
3. Hiperintens
There is 3 intensity in MRI :
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Example :
Water : hypointens in T1 & becomehyperintens in T2
Fat or blood : hyperintens in T1 & T2
Calsification : hypointens in T1 & T2
T1 : longitudinal relaxation time (TR short dan TE
short)T2 : transversal relaxation time (TR long dan TElong)
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Pesawat MRI
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The Advantage of MRI
1. No X ray2. No damage to body if the use is right3. Many examination can do without contrast, not
invasif and not used iodium contrast4. MR can show biologic parameter
(spectroscopy), for example ; can show thedifferent of solid mass, fat/non fat, fluid, & theage of the hemorragic.
5. Can produce 3 D scan/direct multi planarwithout change the patient position .6. Very sensitive for soft tissue morphology
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The Loss of MRI
1. Expensive
2. Take more time for examination
3. Cannot use to Patient with metal(pacemaker, ferromagnetic)
4. Klaustrophoby
5. Need more cooperation from the patient,sometimes need general anesthetic forunstable patient & children.
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MRI : Lacunar Infark
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Indication for Brain MRI
1. Tumor
2. Hemorrhagic Infark /non hemorrhagicperdarahan.
3. Demyelinisation diseases ( multiplesclerotic)
4. Vascular abnormality.
5. Infection
6. Metastasis.
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Brain MRI : normal
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MRI : Subdural Hemorrhage, pre & post kontras
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MRI : Hydrocephalus
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Myelography
Myelography radiology modality which
can show the structure of canalis spinaliswith inject contras in to the canalis
spinalis. Contras can divede in to 2 group :
- Contras negatif : air
- Contras positif : - water soluble
- oil soluble
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The abnormality in myelography:
Hernia nucleus pulpous (HNP)
Tumor, :
- Extradural tumor
- Intradural tumor , divided into :
- intramedular
- extramedular
Congenital abnormality (malformasi):
- meningochele- meningomyelochele
Arachnoiditis
Hernia Nucleus Pulposus
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Hernia Nucleus Pulposus
HNP : protrusion of the disc to posteriorwhich can compress the nerve, medullaspinalis neurological sign.
HNP can find in younger or older patient In younger patient usually caused by
trauma or gravitation of column vertebrawhich receive more weight barring
In older patient usually caused bydegenerative disc process, starting with
disc inertia and then loss of elasticity ofnucleus and degenerative of chondraljoint
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MRI : Nucleus Pulposus
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G di f H i
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Grading of Hernia:
- Protruded intervertebral discProtrution of Nucleus menonjol to one direction withoutannulus fibrous damage
- Prolaps intervertebral discDisplacement of Nucleus but still in annulus ring.
- Extruded intervertebral discNucleus out from the annulus and residing belowthe lig. longitudinal post.
- Sequestrated intervertebral disc
Nucleus penetrate the lig.longitudinal post.
KLINIS : CEFALGIA EC TUMOR OTAK
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MACROADENOMA HIPOFISE
KLINIS : CEFALGIA EC. TUMOR OTAK
KLINIS : HEMIPARESE SNISTRA EC NHS
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ASTROCYTOMA
KLINIS : HEMIPARESE SNISTRA EC. NHS
KLINIS : CARSINOMA THYROID
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KLINIS : CARSINOMA THYROID
CARSINOMA THYROID KANAN
KLINIS : TONSILOPHARINGITIS AKUT
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KLINIS : TONSILOPHARINGITIS AKUT
POLIP SINUS MAXILLARIS KIRI
SINUSITIS SPHENODALIS DA N FRONTALIS
KLINIS : CEPHALGIA + SINUSITIS
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KLINIS : CEPHALGIA + SINUSITIS
PANSINUSITIS
KLINIS : OMSK
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CHOLESTIATOM SINISTRA
KLINIS : SUSPEK POLIP NASI
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SINUSITIS MAXILLARIS KANAN
KLINIS : SUSPEK POLIP NASI
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