Ultrasonography of brain

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Information about Ultrasonography of brain
Health & Medicine

Published on October 1, 2014

Author: CibeleCarvalho3

Source: slideshare.net

Description

Ultrasonography of brain in small breed dogs: how to do, what to see and main applications in veterinary medicine

Ultrasonography of brain Cibele Figueira Carvalho DMV, MSc, PhD Imaging Diagnostic Department - PROVET Researcher INRAD - HCFMUSP

Introduction • Alternative method • Low cost, non-invasive and safe • No anesthesia or contrasts • Allows repeated measurements and monitoring • Small breed dogs (<10kg): good image resolution

Technique Technique •Patient •Equipment •Acoustic windows •Planes of images View slide

Equipment Technique •Patient •Equipment •Acoustic windows •Planes of images Real time equipment with: •linear probes (5 - 10MHz) -neonates and/ or opened rostral fontanelle •high resolution microconvex probes (2 - 6MHz) - adults (small breed dogs) with closed fontanelle View slide

Acoustic windows Technique •Patient •Equipment •Acoustic windows •Planes of images • opened fontanelle (neonates, toy breeds until 3months of age or abnormal) • closed rostral fontanelle (small dogs, thin frontal bone) • Temporal (above zygomatic arch) • Suboccipital CARVALHO, 2004

• Saggital • Transversal • Dorsal Planes of images Technique •Patient •Equipment •Acoustic windows •Planes of images

ROSTRAL WINDOW Transversal Planes CARVALHO, 2014 Saggital Planes Technique •Patient •Equipment •Acoustic windows •Planes of images

Dorsal Planes CARVALHO, 2014 TEMPORAL WINDOW Technique •Patient •Equipment •Acoustic windows •Planes of images

SUBOCCIPITAL WINDOW Technique •Patient •Equipment •Acoustic windows •Planes of images Transversal and Saggital

Anatomy

Anatomy What can we see? • Sulci • Interhemispheric fissure • ventricular system (LV, III, IV, mesencephalic aqueduct) • Cerebellum • Brainstem • Medulla

• Sulci • fissure • Ventricular system • Cerebellum • Brainstem • Medulla Carvalho, 2014 Anatomy

• Sulci • Fissure • Ventricular System • Cerebellum • Brainstem • Medulla 2 4 1 3 2 Cr Ca 4 3 LE 1 D Carvalho et al. 2014 Anatomy

• Sulci • Fissure • Ventricular System • Cerebellum • Brainstem Anatomy • Medulla Cintra, Carvalho et al. 2014

5 7 1 4 3 6 8 2 Cr Ca 7 5 1 4 6 3 2 8 LD V 1- temporal bone 2- temporal lobe 3- presilvian sulci 4- Tentoriun of cerebellum 5- Cerebellum 6- longitudinal fissure 7- Mesencephalon 8- etmoid bone • Sulci • Fissure • Ventricular System • Cerebellum • Brainstem Anatomy • Medulla

• Sulci • Fissure • Ventricular System • Cerebellum • Brainstem Anatomy • Medulla 2 4 1 3 5 2 1 1 6 3 4 Cintra, Carvalho et al. 2014

1 5 6 3 4 Ca LE LD Cr 1 2 3 4 1- subaracnoid space 2- Medulla 3- Canal 4- Atlas 5- dorsal horn 6- ventral horn • Sulci • Fissure • Ventricular System • Cerebellum • Brainstem Anatomy • Medulla

Vascular anatomy • RI brain arteries = 0,55±0,04 (SEO et al.,2005) • RI basilar artery = 0,5 - 0,78 (SAITO et al.,2003)  Arterious circle  Vertebrobasilar system

 Arterious circle  Vertebrobasilar system Vascular anatomy

 Arterious circle  Vertebrobasilar system Vascular anatomy

Vertebrobasilar system  Arterious circle  Vertebrobasilar system

 Arterious circle  Vertebrobasilar system

 Arterious circle  Vertebrobasilar system

Transcranial Ultrasonography of congenital and adquired diseases

Transcranial Ultrasonography of congenital and adquired diseases • Hydrocephaly • Lissencephaly • Cyst (s) • Chiari-like lesions • Dandy walker • Trauma • Neoplasia • Encephalitis Carvalho et al. 2007

Hydrocephalus • Hydrocephaly • Lissencephaly • Cyst • Chiari-like • Dandy walker Carvalho et al. 2007; Carvalho et al. 2010

Lissencephaly • Hydrocephaly • Lissencephaly • Cyst • Chiari-like • Dandy walker

Cysts quadrigeminal and aracnoid • Hydrocephaly • Lissencephaly • Cyst • Chiari-like • Dandy walker Carvalho et al. 2007

Chiari-like • Hydrocephaly • Lissencephaly • Cyst • Chiari-like • Dandy walker Carvalho et al. 2007

Dandy-walker Sindrome • Hydrocephaly • Lissencephaly • Cyst • Chiari-like • Dandy walker Carvalho et al. 2007

Trauma  Trauma  Neoplasias  NME  GME Carvalho et al. 2007

Neoplasias  Trauma  Neoplasias  NME  GME Carvalho et al. 2007

Encephalitis  Trauma  Neoplasias  NME  GME Carvalho, Perez et al. 2012

Encephalitis  Trauma  Neoplasias  NME  GME Carvalho, Perez et al. 2012

Physiology – main considerations • Supply of O2 • Glucose supply • Blood flow supply

Hemodynamic changing diseases Intracranial pressure (ICP) can be increased: •Hydrocephaly •Neoplasia •Encephalitis •Traumas •Neurodegeneration •Strokes

Hydrocephaly • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes • Sonographic images may demonstrate ventriculomegaly but the parameters obtained in B-mode are not suitable for monitoring the treatment and clinical evolution of the disease (Spaulding and Sharp, 1990; Tucker and Gavin, 1996)  Researches show that induced acute hydrocephaly in cats leads to a reduction of 22% in the blood flow of the brain, cerebellum, and encephalic trunk (Hochwald et al., 1975).

• Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes

• Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Carvalho et al., 2010

Neoplasias • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes • Tumoral vessels are not always detected • Hemodynamic changes may occur because “mass effect” (stenosis), neoangiogenesis or trombosis • Intracranial pressure arising leads to elevated RI

• Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes

Encephalitis • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes • Granulomatous meningoencephalitis (GME) - hemodynamic changes are variable and progressive with the disease Carvalho et al., 2012

• Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes

Color Doppler image demonstrated conspicuous vessels in the arterial circle that appeared tortuous and more obvious than usual with minimum adjustments on color gain settings • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes

- Some ventriculomegaly degrees - Focal hyperechoic lesion (granuloma) - the diffuse brain congestion and inflammation can lead to a compensatory vasodilatation • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes

• Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes - Doppler spectral mapping can demonstrate low or high resistive index depending on mechanical compression (e.g., stenosis or occlusion) caused by the perivascular cuffs observed in pathologic evaluation, or space-occupying mass

• Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Granulomatous meningoencephalitis in a dog – increased blood vessels caliber; inflammatory process with mononuclear cells around subpial surface and ocluded blood vessels (hematoxilin eosin stain; scale 100 μm). Photo: Paulo C. Maiorka.

GME after treatment – histopathologic Degenerated areas; Partial lumen desobstruction; Increased vessels caliber • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes

Trauma • Focal lesion detection varies with location, extension and collateral damages; • Vessels change can be present or not • Focal lesion can cause “mass effect” and intracranial pressure (ICP) increase • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes

• Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes ICP x RI •RI is correlated to intracranial pressure (ICP) in patients with severe brain damage and in hydrocephalic infants; •and detecting brain death (after head injury) Rainov, 2000; Fukushima et al., 2000

• Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration Neurodegeneration • Strokes Neurodegeneration process displays some common morphological characteristics: •cortical cerebral atrophy, •ventricles enlargement, •diffuse deposits of β-amyloid (A) peptides, •senile plaques formation, •lipofuscin and intraneuronal “aging pigment” accumulations changing the cytoskeleton, •vascular changes in the cerebrum.

• Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration Neurodegeneration • Strokes Carvalho, 2009; Carvalho, 2012

• Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Brain strokes or cerebrovascular accidents • Stroke is the most common clinical manifestation of cerebrovascular disease, and can be broadly divided into ischemic and hemorrhagic stroke (Braund, 1994).

• Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes

• Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Carvalho et al., 2012

• Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Carvalho et al., 2012

• Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Carvalho et al., 2012

• Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Carvalho et al., 2012

Risk factors: Hyperlipemia Diabetes mellitus hypothyroidism hyperadrenocorticism Arterial Hypertension (might) Cardiac insufficiency Severe hypotension Hemorragic conditions Chronic lung diseases (hypoxia) Congenital condition Ex: Beagle’s vasculitis, cat’s idiopatic ischemic disease, Schnauzer’s hyperlipemia • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes

Brain stroke • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Carvalho, 2012

In conclusion... - Useful tool that can trial small breed dogs with neurologic signs

References CARVALHO CF, ANDRADE NETO JP. Encéfalo In: Ultrassonografia em pequenos animais. 2ed. Editora Roca, São Paulo. 2014. CARVALHO CF, ANDRADE NETO JP, JIMENEZ CD, DINIZ SA, CHAMMAS MC. Ultrassonografia transcraniana em cães com distúrbios de origem central. Arq. Bras. Med. Vet. Zootec., v.59, n.6, p.1412-1416, 2007. CARVALHO CF, CINTRA TCF, ANDRADE NETO JP. Ultrassonografia Doppler transcraniana. In: Carvalho, CF Ultrassonografia Doppler em pequenos animais. Editora Roca, 2009. CARVALHO CF, PEREZ RB, CHAMMAS MC, MAIORKA PC. Transcranial Doppler sonographic findings in granulomatous meningoencephalitis in small breed dogs. Canadian Veterinary Journal v.53, p.855–859, 2012. CARVALHO CF, ANDRADE NETO JP, DINIZ SA. Small breed dogs with confirmed stroke: concurrent diseases and sonographic findings. Arq. Bras. Med. Vet. Zootec., v.64, n.5, p.1177-1183, 2012. CINTRA TCF, CARVALHO CF, CANOLA JC, NEPOMUCENO AC. Ultrassonografia transcraniana em cães hígidos: padronização da técnica e descrição anatômica. Arq. Bras. Med. Vet. Zootec., v.66, n.1, p.61-68, 2014.

BERG, D.; GODAU, J.; WALTER, U. Transcranial sonography in movement disorders. Lancet Neurology. v.7, p.1044-1055, 2008. HUDSON, J. A. et al. Ultrasonographic anatomy of the canine brain. Veterinary Radiology, v. 30, n. 1, p. 13-21, 1989. HUDSON, J. A.; SIMPSON, S. T.; COX, N. R. Ultrasonographic examination of the normal canine neonatal brain. Veterinary Radiology, v. 32, p. 50-59, 1991. SAITO, M.; OLBY, J. N.; SPAULDING, K. Identification of arachnoid cysts in the quadrigeminal cistern using ultrasonography. Veterinary Radiology & Ultrasound, v. 42, n.5, p.435-439, 2001. GAROSI, L. S. Cerebrovascular disease in dogs and cats. Veterinary Clinics of North America: Small Animal Practice, v. 40, p. 65-79, 2010. HILLOCK, S. M. et al. Vascular encephalopathies in dogs: incidence, risk factors, pathophysiology, and clinical signs. Compendium on Continuing Education for the Practicing Veterinarian, v. 2, n. 3, p. 196-207, 2006. LILLEHEI, K. O.; CHANDLER, W. F.; KNAKE, J. E. Real time ultrasound characteristics of the acute intracerebral hemorrhage as studied in the canine model. Neurosurgery, v.14, n.1, p. 48-51, 1984.

PLATT, S. R.; GAROSI, L. Canine cerebrovascular disease: Do dogs have strokes? Journal of the American Animal Hospital Association, v. 39, n. 4, p. 337-342, 2003. DE LAHUNTA, A.; GLASS, E. Veterinary neuroanatomy and clinical neurology. 3rd ed. Philadelphia: Saunders, 2009. HOSKINS, J. D.; SHELTON, G. D. The nervous and neuromuscular systems. In: HOSKINS, J. D. Veterinary pediatrics. 3rd. ed. Philadelphia: W.B. Saunders Co., 2001. Cap. 19, p. 425. FUKUSHIMA, U. et al. Evaluation of intracranial pressure by transcranial Doppler ultrasonography in dogs with intracranial hypertension. Journal Veterinary Medical Science, v. 62, n. 3, p. 353-355, 2000. SPAULDING, K. A.; NICHOLAS, J. H.; SHARP, B. Ultrasonographic imaging of the lateral cerebral ventricles in the dog. Veterinary Radiology, v. 31, n. 2, p. 59-64, 1990. BRAUND, K. G. Neurological syndromes. In: __ Clinical neurology in small animals: localization, diagnosis and treatment. New York: International Veterinary Information Service, 2003. SAITO, M. et al. Magnetic resonance imaging features of lissencephaly in 2 lhasa apsos. Veterinary Radiology & Ultrasound, v. 43, n. 4, p. 331-337, 2002.

Doubts???? Thank you for your attention! cibelefcarvalho@gmail.com

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