1. brain
From the brain and from the brain only, arise our pleasures, joys, laughter and jests, as well as our sorrows, pains, grief's and tears. ~Hippocrates
Marilyn Rose

2. meninges 3 membranes Outer- Dura mater- folds house the following:
flax cerebri- cerebral hemisphere
tentorium cerebelli – cerebrum/ cerebellum
falx cerebelli- cerebellar hemispheres
Middle- arachnoid- separate from dura by subdural space.
Inner- Pia mater- vascular, adhering to the brain- separated from arachnoid by subarachnoid space- which is where CSF circulates

3. Brain Bleeds- Hematoma
Subarachnoid-
Rupture AVM/ aneurysm
Worst headache of life
Between arachnoid and pia
Epidural
Traumatic (artery)
Blood between dura and skull
Subdural
Traumatic (vein)
Shearing/ shaken baby
Blood between arachnoid and dura

4. Subarachnoid
Epidural
Subdural

5. tent, falx and cerebellum
Falx cerebelli
Tentorium
cerebelli
Tent
Cerebellum= Posterior Fossa

6. ventricular system
Circulation of CSF though CNS
4 cavities:
RT/LT lateral vents- one in each cerebral hemisphere separated by cavum septum pellucidum (frontal, (atria) occipital, temporal horns)
Choroid plexus- blood vessel network (bright) within lateral ventricles - producing CSF- BEGINS POSTERIOR TO 3rd vent
3rd opens downward-foramen of Monro- lateral= thalamus
4th opens from cerebral aqueduct- anterior to cerebellum and posterior to the pons- CSF goes though Magendie (Cisterna magna-spinal cord) and Luschka (subarachnoid space)

7. Head Ultrasound… 3rd vent- blood anterior Level of 3rd with blood
Normal Choroid posterior to 3rd vent

9. axial Pre and post birth imaging of the brain Coronal Sagittal
Sagittal
axial

10. Choroid Plexus Normal or abnormal??? Level of the 3rd ventricle
Level of the 3rd ventricle

11. cerebrum cortex- gray/white matter
Rt/Lt hemispheres
Gyri- folds
Sulci- groove- central sulcus
frontal (motor) / parietal lobe (sensory)
Fissures- deeper grooves-
longitudnal- superior sagittal sinus/ flax (Rt/Lt)
lateral- Sylvian- frontal/ parietal from temporal lobe.
Corpus callosum- largest bundle of white matter w/ in
cerebrum forms roof of the lateral vents
connects Rt/ Lt cerebral hemispheres
4 parts= rostrum, genu, body, splenium

12. Corpus Callosum

13. Locate the corpus callosum…

14. What is wrong?

15. Label the arrows- 1,4, 6, 7…

16. Cisterns
Subarachnoid space- areas at brain base that are widened where CSF pools.
Supracellar cistern- superior to sella- C of W
Quadrigeminal cistern- posterior to quadrigeminal plate of midbrain
Cisterna magna- lower posterior fossa (largest)

17. Cisterns

18. What is wrong?

19. Cerebral Lobes Cortex divided into 4 lobes:
Frontal- anterior- reason, judgment, vol muscle
Broca’s area for speech- LT frontal gyrus
Parietal- middle of each hemisphere- post to central sulcus- temperature, touch, pain, taste
Occipital- posterior- visual stimuli from thalamus
Temporal- anterior to occipital-auditory/olfactory
Primary auditory= Heschl’s- auditory info
Secondary= Wernicke’s – comprehension/ speech

20. Cerebral lobes

21. temporal
cerebellum

22. Case study= Heat Stroke
The described imaging findings in heat stroke include early cerebral edema , loss of gray-white matter differentiation, patchy high signal intensity of the white matter of cerebral hemispheres and vascular boundary zone infarcts and in later stages, diffuse cerebellar atrophy -severe brain ischemia was the underlying cause for the neurological involvement in heat stroke in our patient.

23. Basal Ganglia Subcortical gray matter
Caudate nucleus- lat to each lat ventricle
Lentiform nucleus
Claustrum
Together they plan and program muscle action.

24. Diencephalon Thalamus Hypothalamus Epithalamus
Lg oval grey masses, walls of lat vents, connects in mid 3rd vent by massa intermedia
Hypothalamus
Inferior to thalamus and posterior to optic chiasm, making floor of lat vent- Pituitary Gland (hypophysis)- connected by infaundibulum.
Epithalamus
Pineal gland- melatonin= day/night cycles (can Ca++)

25. Limbic System Interconnected fibers adjacent to temporal lobes.
Emotional aspects of behavior
Includes: hippocampus (short- long term memory converter), amygdala, olfactory tracts, fornix, cingulate gyrus..
Brain injury to hippocampus can cause…..
Loss of memory…

26. Limbic system

27. Brainstem Major segments are: Midbrain
Above the pons, smallest portion of brainstem
Nerve bundles called cerebral peduncles and quadrigeminal plate.
Surrounds the cerebral aquaduct- which connects the 3rd and 4th vents and contains CSF
Pons
Oval expansion of brainstem- “Bridge”- signals to spinal cord and cerebral cortex
Medulla oblongata
Extends to the spinal cord which exits the foramen magnum- heart rate, respiratory rate and blood pressure.

28. Brainstem

29. Cerebellum “Little brain”
Posterior to brainstem and occupies posterior fossa
Composed of two cerebellar hemispheres with a midline Vermis- on the inferior surface lie the cerebellar tonsils
Occassionally they may herniate down the foramen magnum…..called what????

30. Cerebellum

31. Cerebellum
Dandy Walker= refers to the enlargement of the posterior fossa secondary to cystic dilatation of the fourth ventricle as well as hypoplasia of the cerebellum and vermis.

32. What is wrong? Lt cerebellar abscess
Congenital absence of one cerebellar hemisphere

33. Types of brain lesions…
PNET-Primitive Neuroectodermal tumors
PNET can occur anywhere in the brain of a child, although the most common place is in the back of the brain near the cerebellum. When they occur here, they are called medulloblastomas. The symptoms depend on their location in the brain, but typically the child experiences increased intracranial pressure. These tumors are fast growing and often malignant, with occasional spreading throughout the brain or spinal cord.

34. Cerebral Vasculature Arteries in the brain are thin and weak.
high risk for aneurysms and strokes.
No valves in the veins-blood can flow in either direction= route for blood-bourne pathogens.
Dural sinus drains down to the IJ’s- through the superior and inferior sagittal sinus
Unique capillaries create the Blood Brain Barrier

35. Arterial- Blood to Brain
Paired internal carotid and vertebral arteries.
Internal carotid becomes- Carotid Siphon
Anterior cerebral-ACA
Middle cerebral-MCA
Circle of Willis= Located in Suprasellar cistern- cerebral arterial circle- anastomosis of 4 major arteries….
What are they?
Two vertebral and Two carotids….
becoming the anterior/posterior cerebral, anterior/posterior communicating and internal carotids

36. Brain Blood Supply

37. Circle of Willis

38. Venous Blood Parietal Veins Superior Sagital Sinus Confluence of Sinus
Transverse Sinus
Sigmoid Sinus
Internal Jugular Veins

39. Which is it? MCA stroke- frontal/temporal lobe with
Wedge shaped area of decreased density and
Slight midline shift/ mass effect
Aneurysm
AVM

40. Cranial Nerves 12 cranial All but 1st and 2nd arise from the brainstem
Each nerve corresponds to a function in the body
Olfactory- smell- superior nasal septum
Optic-sight-posterior aspect of eye
Facial-lower pons- control facial muscles
Vagus-”wandering”- down to splenic flexure of abd and arise from medulla oblongata- enervates many abdominal organs

41. Cranial Nerves