CT:

MRI
-

Suspected skull fracture,

Suspected intracranial bleed (acute bleeds appear white on CT scan within 20 min of onset,
intracerebral hemorrhage and SA bleeds
Trauma: safer, faster
Monitoring hydrocephaluss: monitoring increase in ventricle size
T1: bone = no signal, CSF, black, gray matter is darker, white matter is lighter. Used for studying
anatomy of brain. Very bright areas will contain high degree of fat, protein subacute bleed or
contrast agent. Can use gadolinium enhancement to increase resolution
TW: bone: no signal, gray matter is lighter, white matter is darker, and CSF appears white,
pathology will be white due to edema and water accumulation in areas of pathology.
Fluid attenuation inversion recovery (FLAIR imaging): bright CSF is subtracted away,
Diffuse weighted imaging DWI): T2 sequence, used in suspected stroke to determine if ischemic
event is occurring. Ischemic areas will be white

Stroke
- MCA: CL trunk/arm/face, Brocas Wernickes (dominant, neglect (non-dominant)
- ACA: leg/foot/ cognitive changes, bladder incontinence
- PCA: vision reading writing
- Basilar: coma, locked in syndrome, CN palsies, drop attacks
50-80
Leukocytes
& PMNS
Protein
Glucose
Lab cultures

Usually inc (100300)

<5
>1000
0
>50%
20-45
100-500
>50 or 75% serum <40 or <66%
glucose
serum
Gram stain of CSF

Neonates <1 month

Infants (1-24 months)
Children >24 month
-

Normal or slightly
inc (80-150)
100-500
<20%
50-200
Generally normal
CSF PCR may sow
HSV or
enterovirus

Bacteria
GBS, gram neg enteric bacilli,
listeria, e coli
Strep pneumo, Neisseria
meningitis, H influenzae type b

Usually inc
10-50
Varies
25-500
<50, continues to
dec if not treated
Budding yeast,
serum and CSF
cryptococcal
antigen

Treatment
Ampicillin and gentamicin or
ampicillin and cefotaxime
3rd generation cephalosporin,
add vanc until sensitivities are
known

Same

ADEM: postviral or para infectious AI process targeted against CNS myelin that leads to
inflammation of white matter in brain and SC>
o Presents wit h headache, lethargy, coma seizures, stiff neck, fever, ataxia, optic neuritis,
transverse myelitis, monoparesis, bladder/bowel dysfunction

o Lesions found a junction of deep cortical gray and subcortical white matter (MS lesions
are periventricular)
o MRI: increased T2 signal intensity, CSF shows increased opening pressure and
lymphocytes
o Tx with corticosteroids
Transverse myelitis: acute inflammation of SC that leads to demyelination and spinal cord
dysfunction: AI, viral illness or occur in pt with CT disease
o Hours to weeks development
o Localized back pain, arm/leg weakness, sensory disturbances (numbness, tingling
burning) and bladder/bowel dysfunction
o MRI: spinal cord swelling and T2 signal intensity at affected level
o CSF shows increased protein and lymphocytes
Brain abscess
o S aureus: penetrating head wound
o Strep
o Anaerobic: Gram pos cocci, Bacteroides, Fusobacterium, prevotella, actinomyces,
clostridium
o GN aerobic: enteric rods, proteus, pseudomonas, citrobacter diversus, Haemophilus
o Ring enhancing lesions, WBC count normal or increased
o If organism is unknown: vanc, 3rd generation cepha and Flagyl are given