Dr.

ILMA FIDDIYANTI

Central Nervous System

Consists of:
Cerebrum Telencephalon
Brain stem Truncus Cerebri
Spinal Cord Medulla Spinalis

Central Nervous System

Cerebrum (Telencephalon) - subdivided
into four lobes:
Frontal Lobes
Parietal Lobes
Occipital Lobes
Temporal Lobes

Central Nervous System

Brain stem (Truncus Cerebri) consists
of:
Medulla Oblongata (MO)
Pons
Midbrain (Mesenchephalon)

Central Nervous System

Cerebellum
Location:
Above the brainstem & beneath the occipital lobes
at the base of the skull

Fcns
Rapid integration of sensory input for equilibrium
Influences muscle tone, posture, fine & skilled
movements
Balance & Equilibrium

Central Nervous System

Spinal Cord (Medulla Spinalis)
16-18 long
Runs from the foramen magnum to the disc
level between L1-L2
Has 31 pairs or 62 spinal nerves:
Clinical Pearl: only the spinal cord itself is a part
of the CNS

Central Nervous System

Spinal Cord (Medulla Spinalis)
Composed of:
Gray Matter Substantia Grisea
White Matter Substantia Alba

Hindbrain

Midbrain

Forebrain: Diencephalon

Forebrain: Telencephalon

Forebrain: Limbic System

Hemispheres

Cortex: 4 Lobes

Vascular: Circle of Willis

Vascular (Blood Supply) System

Ventricles

Axial (canthomeatal) Cranial CT

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Axial (canthomeatal) Cranial CT

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Axial (canthomeatal) Cranial CT

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Axial (Canthomeatal) Cranial

CT

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Axial (canthomeatal) Cranial CT

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Axial (canthomeatal) Cranial CT

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Layers of Protection: Skull and

Meninges

Layers of Protection: Skull

and Meninges

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Extra-axial collections

Brain herniation
1.Subfalcine herniation
2.Transtentorial herniation
- Descending (Uncal herniation)
- Ascending
3. Tonsillar herniation
4. External herniation

Brain herniation causes compression of brain, brain stem, nerves, and

blood vessels againts the rigid bony and dural margins

Skull Fracture
NECT scan shows acute
SDH (A, black arrow) with
nondisplaced linear skull
fracture (B, open arrow),
overlying
soft
tissue
swelling (B, white arrow).

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Subarachnoid Hematoma
(SAH)
NECT scan shows edematous
right hemisphere, traumatic
SAH over left hemisphere,
overlying scalp swelling.

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Subdural Hematoma (SDH)

E/:
Avulsi v.pontine
Terbukanya granulatio pacchioni
Terlukanya PD pia mater / perdarahan
contusio cerebri

NECT scan shows SDH

Hematome meluas melewati ruang

subdural mengenai gyrus mayor
hemiphere cerebri dan menekan otak
60-80th
Terdiri atas:
- Acute Sub Dural Hematoma
- Acute Sub Dural Hygroma
- Chronic Subdural Hematoma(CSH)

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Subdural Hematoma

A. Acute SDH; B. subacute SDH;C. Chronic SDH; D.

Chronic SDH with acute bleed.
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Epidural Hematoma
Perdarahan:
a. meningea media atau saalh satu
cabangnya
vena di dalam granulatio pacchioni/
sinus
tabula interna tulang calvaria
>>> Temporo-parietal
fossa cranial posteriol lebih bahaya
Darah mengangkat duramater dari
calvaria
Lesi hiperdens berbentuk biconveks
(ellips) atau plano convex pada os
calvaria, batas tegas,, terlihat mass
effect
EDH kronis mixed density area
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Epidural Hematoma (EDH)

NECT scan show a rapidly developing EDH

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Intraventricular Hematoma (IVH)

& Cortical Contusion

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Stroke
Intracerebral Hemorrhage (ICH)

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Stroke
Left lentiform nucleus infarction

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Case 1

20-year-old woman with motorcycle accident

Case 2

25-year-old man with motorcycle accident

Brain herniation
1.Subfalcine herniation
2.Transtentorial herniation
- Descending (Uncal herniation)
- Ascending
3. Tonsillar herniation
4. External herniation

Brain herniation causes compression of brain, brain stem, nerves, and

blood vessels againts the rigid bony and dural margins

Case 4

63-year-old patient with hypertension and left hemiparesis

Case 5

A patient with sudden onset of headache and alteration of

consciousness

Case 6
Acute MCA infarction

78 year-old woman with sudden left hemiparesis 1 day PTA

NECT shows a hypodense area of large infarction involving
the right middle cerebral artery vascular territory.

Case 7
32 yo, Diagnosis CT?

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Case 8

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Case 9

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Case 10

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Case 11

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Lesi Intrakranial

SDH
EDH

ICH

IVH

Difus Injury berdasarkan CT Scan

Category
Diffuse Injury I
Diffuse injury II

Initial CT findings
No vissible pathology.
Cisterns are present; midline shift
< 5mm and/or lesion densities
present, no high or mixed density
lesion > 25 ml, may include bone
fragmens and foreign bodies.
Diffuse injury III Cisterns are compressed or absent
(swelling)
midline shift 0-5 mm, no high or
mixed density lesion > 25 ml.
Diffuse injury IV Midline shift > 5 mm, no high or
(Shift)
mixed density lesion > 25 ml.
Evacuated mass
Nonevacuated mass

Any lesion surgically evacuated.

High or mixed density lesion >
25 ml, not surgically evacuated.

What is bright/dark on CT?

The more dense the
tissue, the brighter it
looks on CT
Any calcified structure
(like the skull)
appears bright
New hemorrhage in
the brain is also bright
Water (or CSF) looks
dark on CT

The two most common types of

MR images are
T1-weighted MR imagesuseful to look at normal
anatomy of the brain
T2-weight MR images useful to look at abnormal
processes (or pathology)
in the brain

What is bright/dark on T1?

Fat is bright
White matter (inner
part of brain) is
brighter than gray
matter (cortex or
outer part of the
brain)
Water (CSF) is dark

What isBELAJAR
bright/dark
SELAMAT

on T2?

Water is bright
Blood is bright
White matter is darker
than gray matter

SKULL X-RAY

FRAKTUR TULANG

Trauma Kepala
Linier Fraktur

Trauma Kepala
Depresi Fraktur

Trauma Kepala
Stellate Fraktur

Trauma Kepala
Pneumocephalus

Trauma Kepala
Cephalhematoma

Fraktur Facial
Le Fort I Fraktur

Fraktur Facial
Le Fort II Fraktur

Fraktur Facial
Le Fort III Fraktur

Fraktur Cervical
clay shoveler's Fraktur

Fraktur Cervical
Teardrop Fraktur

Fraktur Cervical
Hangmans Fraktur

Fraktur Cervical
Lamina Fraktur

Fraktur Cervical
Jefferson Fraktur

Fraktur Vertebra
Burst Fraktur

Fraktur Vertebra
Wedge Fraktur

Chip Fraktur

Avulusi Fraktur

Green stick Fraktur

Hairline Fraktur

Oblique Fraktur

Spiral Fraktur

Transverse Fraktur

Comminuted Fraktur

Fraktur Extremitas Inferior

Salter Harris Type III Fraktur

Fraktur Extremitas Superior

Boxers Fraktur

Fraktur Extremitas Superior

Kompresi/Buckle/Torus Fraktur

Fraktur Extremitas Superior

Galeazzi Fraktur

Fraktur Extremitas Inferior

Monteggia Fraktur

Fraktur Extremitas Superior

Coles Fraktur

Fraktur Extremitas Superior

Smiths Fraktur

Fraktur Extremitas Superior

Barton's Fraktur

Fraktur Extremitas Superior

Chauffeur Fraktur

Fraktur Extremitas Superior

Bennett Fraktur

SELAMAT BELAJAR