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NEURORADIOLOGY - Coggle Diagram
NEURORADIOLOGY
Divisions of CNS
Brain
Spinal cord
end near L1.
Narrowed area called conus medullaris
Nerve root extends to 1st coccyx segment.
Subarachnoid space continues to S-2.
Subarachnoids space contains CSF.
Lumbar puncture site L3-L4
Protective coatings
(Meninges Covers brain)
Dura meter, 2 layers
Arachnoid space, between Dura & Pia meter
Pia meter, inner most layer
(thin, highly vascular, next to brain)
Meningeal spaces
(Exterior to layer is a space)
Epidural space; between dura meter & skull.
Subdural space; between dura meter& arachnoid
Subarachnoid space; between arachnoid & pia meter….FILLED WITH CSF.
MYELOGRAPHY
Radiographic study of spinal cord by Injection of contrast into subarachnoid space
Indications of Myelograph
y
Spinal cord tumors
Cysts
Arachnoiditis
Spinal nerve root injury
Neurofibromas
Tumors in posterior fossa of the skull
Spinal stenosis
Cervical spondylosis
Spinal tuberculosis
Contraindications of Myelography
Increased intracranial pressure
Intracranial disease
Infection at the puncture site
Coagulopathy
Disadvantages:
Invasive
complications
(CSF leak, headache, contrast reaction, etc.)
Ionizing radiation and iodinated contrast.
Limited coverage.
Advantages:
Defines extent of subarachnoid space,
identifies spinal block. .
Contrast Media
Water-soluble
non-ionic
injectible
(Niopam, Isovue, Omnipaque) :
contrast media of choice.
Pre-procedure care
Keep patient well hydrated to minimize
headaches.
Preparation of the patient
• Explain procedure
• Consent form signed
• Puncture area cleaned
Equipments
• Grid cassettes
• Myelography tray
• Sterile gloves
• Antiseptic solution
• Lab request
• Large sponge pillow
The procedure
Lumbar puncture (L2/3 or L3/4)
• Lateral cervical or Cisternal puncture (C1/2)
• Sacral Hiatus puncture
Films
pt erect or semi-erect:
AP
450 RPO & LPO (to see the nerve roots)
Lateral
Laterals in flexion/extension (may show posterior disc protrusion and any spinal instability.
patient supine & the table horizontal:
AP
Shoot through lateral
Discography
The radiographic investigation of selected intervertebral fibrocartilages (disks)
Indications
Symptomatic disc degenaration without radicular signs.
• Traumatic annular tears and ruptures.
• Suspected disc prolapse.
• Acute traumatic intraosseous disc herniation.
• Assessment of discs above or below a mechanically altered segment
spondylolisthesis
transitional vertebrae, etc.
post surgital fusion,
• Biopsy.
• Post-discectomy syndromes.
• Confirmation of a normal disc above or below a proposed surgical fusion.
Contraindications
• Papilloedema
• Recent lumbar puncture
• Previous adverse reaction to intrathecal injection of the same CM.
• Any local or distant sepsis will add to the risk of infective discitis.
Contrast medium
• Meglumine salts
Eg: Urografin 310M or non-ionic CM
Equipment
Fluoroscopy unit with spot film facility
Discography needles
Procedure
Prone or left lateral
Needle inserted
contrast injected up to 1 ml into disk
Patient asked to describe pain
Radiographs taken
:
Lateral & PA with needles
Lateral & PA without needles
Risk associated
• Disktitis (most common).
• Nerve root injury.
• Urticaria ( a vascular reaction on the skin)
• Injection of sac into the dural sac.
• Bleeding.
• Nucleus polposus pulmonary embolism
• Nausea, headache and increased pain.