Role of mdct in evaluation of different types Haemorrhages

stroke in brain special in old age patient

Centurion University of Technology & Management

Odisha
 A PROJECT REPORT
Submitted by

SHREYOSI DASH
REGD. NO- 211704400014
in partial fulfillment for the award of the degree of
BACHELOR OF MEDICAL RADIATION
TECHNOLOGY
in
- - - - 2021-2024- - - - - - - -

DEPARTMENT OF RADIOLOGY

SCHOOL OF PARAMEDICS AND ALLIED HEALTH SCIENCES

BHUBANESWAR CAMPUS

CENTURION UNIVERSITY OF TECHNOLOGY AND MANAGEMENT

ODISHA
MARCH 202
 BONAFIDE CERTIFICATE

“Role of mdct in evaluation of different types Haemorrhages stroke in brain

special in old age patient” is the bonafide work of “SHREYOSI DASH –
211704400014” who carried out the project work under my supervision. This is
to further certify to the best of my knowledge, that this project has not been
carried out earlier in this institute and the university.

SIGNATURE
Asst. Professor

Certified that the above-mentioned project has been duly carried out
as per the norms of the college and statutes of the university

SIGNATURE
MS. SOUMYA JAL

DEAN OF THE SCHOOL

Professor

DEPARTMENT SEAL
 SPECIMEN COVER PAGE

Role of mdct in evaluation of different types

Haemorrhages stroke in brain special in old age
patient

A PROJECT REPORT
Submitted by

SHREYOSI DASH - 211704400014

in partial fulfillment for the award of

the degree of

BACHELOR OF MEDICAL RADIATION

TECHNOLOGY

in
PARAMEDICS AND ALLIED HEALTH SCIENCE

SCHOOL OF PARAMEDICS AND ALLIED HEALTH SCIENCE

BHUBANESWAR CAMPUS

CENTURION UNIVERSITY OF TECHNOLOGY AND MANAGEMENT

ODISHA
MARCH 2024
 SPECIMEN CERTIFICATE

DEPARTMENT OF RADIOLOGY

SCHOOL OF PARAMEDICS AND ALLIED HEALTH SCIENCE

BHUBANESWAR CAMPUS

BONAFIDE CERTIFICATE

Certified that this project report Role of mdct in evaluation of different types
Haemorrhages stroke in brain special in old age patient is the bonafide work of
“SHREYOSI DASH – 211704400014 who carried out the project work under my
supervision. This is to further certify to the best of my knowledge, that this project has
not been carried out earlier in this institute and the university.

SIGNATURE

Asst. Professor

Certified that the above mentioned project has been duly carried out as per
the norms of the college and statutes of the university.

SIGNATURE
Ms. Soumya Jal
DEAN OF THE SCHOOL

Professor of Paramedics and Allied Health Sciences

DEPARTMENT SEAL
 DECLARATION

I hereby declare that the project entitled “Role of mdct in evaluation of different types Haemorrhages stroke
in brain special in old age patient” submitted for the “Project” of 6th semester Bsc. MRT is my original work
and the project has not formed the basis for the award of any Degree / Diploma or any other similar titles in
any other University.

Name of the Student: SHREYOSI DASH

Signature of the Student:

Registration No: 211704400014

Place: Bhubaneswar

Date:
 ACKNOWLEDGEMENT

I wish to express my profound and sincere gratitude to Asst. Prof., Ms. Ashwati Krishna Department of
Radiology, SoPAHS, Bhubaneswar Campus, who guided me into the intricacies of this project nonchalantly
with matchless magnanimity.

I thank Prof. Monali Mishra, Head of the Dept. of SoPAHS, Bhubaneswar Campus and Prof. Soumya Jal, Dean,
School of Paramedics and Allied Health Sciences, Bhubaneswar Campus for extending their support during
Course of this investigation.

I would be failing in my duty if I don’t acknowledge the cooperation rendered during various stages of my
project.

I am highly grateful to my friends who evinced keen interest and invaluable support in the progress and
successful completion of my project work.

I am indebted to my family for their constant encouragement, co-operation and help. Words of gratitude are
not enough to describe the accommodation and fortitude which they have shown throughout my endeavor.

Name of the Student: Shreyosi Dash

Signature of the Student:

Registration No: 211704400014

Place: Bhubaneswar

Date:

TABLE OF CONTENTS
LIST OF FIGURES ………………………………………………………………………………………….i
LIST OF TABLES ……………………………………………………………………………………………ii
Chapter-1……………............................................................................................ 1
Introduction …………………………………………………………………………………………………1
1.1 MDCT………………………………………………………………………………………………….1
1.2 CT Scan of brain…………………………………………………………………………………..1
1.3 Anatomy of the brain................................................................................1
Chapter-2 ………………………………………………………………………………………………………2
Review of Literature ………………………………………………………………………………………2
2.1 RL1 ………………………………………………………………………………………………………2
2.2 RL2 ………………………………………………………………………………………………………2
Chapter – 3 ……………………………………………………………………………………………………3
Aim and Objectives ………………………………………………………………………………………..3
3.1 Aim…….…………………………………………………………………………………………………3
3.2 Objectives…………………………………………………………………………………………….3
3.3 Different types of hemorrhage ……………………....….……....….….….….………..3
Chapter – 4 …………………………………………………………………………………………………….4
Materials and Methods ………………………………………………………………………………….4
4.1 Methods …………..………………………………………………………………………………….4
4.2 Materials ……………………………………………………………………………………………..4
Chapter-5……………………………………………………………………………………………………….5
Results …………………………………………………………………………………………………………..5
Chapter-6 ……………………………………………………………………………………………………..6
Discussion and Conclusion …………………………………………………………………………….6
APPENDIX ……………………………………………………………………………………………………..7
REFERENCES ………………………………………………………………………………………………….8
 CHAPTER -1

INTRODUCTION

1.1 MDCT :-

Multidetector CT (MDCT, multislice CT, multidetector-row CT, multisection CT)

represents a breakthrough in CT technology. It has transformed CT from an transaxial

cross-sectional technique into a true 3D imaging modality that allows for arbitrary

cut planes as well as excellent 3D displays of the data volume. Multislice CT scanners

provide a huge gain in performance that can be used to reduce scan time, to reduce

section collimation, or to increase scan length substantially. The following article will

provide an overview of the principles of multislice CT scanning. It describes the

various detector systems and gives an introduction to the most important acquisition

and reconstruction parameters. The article describes how reconstruction of thick

multiplanar reformations can be used to take advantage of the 3D capabilities of

multislice CT while keep radiation exposure to a minimum.

1.2 CT Scan of Brian

A CT of the brain is a noninvasive diagnostic imaging procedure that uses special X-rays

measurements to produce horizontal, or axial, images (often called slices) of the brain.

Brain CT scans can provide more detailed information about brain tissue and brain

structures than standard X-rays of the head, thus providing more data related to injuries

and/or diseases of the brain.

During a brain CT, the X-ray beam moves in a circle around the body, allowing many

different views of the brain. The X-ray information is sent to a computer that interprets

the X-ray data and displays it in a two-dimensional (2D) form on a monitor.

1.3 Anatomy of the Brain

Fig 1.1 Anatomy of the brain

 Cerebrum :- The cerebrum (supratentorial or front of brain) is composed of the right and left
hemispheres. Functions of the cerebrum include: initiation of movement, coordination of movement,
temperature, touch, vision, hearing, judgment, reasoning, problem solving, emotions, and learning.

 Brainstem :- The brainstem (midline or middle of brain) includes the midbrain, the pons, and the
medulla. Functions of this area include: movement of the eyes and mouth, relaying sensory messages
(hot, pain, loud, etc.), hunger, respirations, consciousness, cardiac function, body temperature,
involuntary muscle movements, sneezing, coughing, vomiting, and swallowing.

 Cerebellum :- The cerebellum (infratentorial or back of brain) is located at the back of the head. Its
function is to coordinate voluntary muscle movements and to maintain posture, balance, and
equilibrium.

 Pons :- A deep part of the brain, located in the brainstem, the pons contains many of the control
areas for eye and face movements, facial sensation, hearing, and equilibrium.
 Medulla :- The lowest part of the brainstem, the medulla is the most vital part of the entire brain and
contains important control centers for the heart and lungs.

 Spinal cord :- A large bundle of nerve fibers located in the back that extends from the base of the
brain to the lower back, the spinal cord carries messages to and from the brain and the rest of the
body.

 Frontal lobe :- The largest section of the brain located in the front of the head, the frontal lobe is
involved in personality characteristics and movement.

 Parietal lobe :- The middle part of the brain, the parietal lobe helps a person to identify objects and
understand spatial relationships (where one’s body is compared to objects around the person). The
parietal lobe is also involved in interpreting pain and touch in the body.

 Occipital lobe :- The occipital lobe is the back part of the brain that is involved with vision.

 Temporal lobe :- The sides of the brain, these temporal lobes are involved in memory, speech, and
sense of smell.
 CHAPTER - 2

LITERATURE REVIEW

Article name Author Reference Results

Computed tomographic Pipat Chiewvit, Siriraj Hospital from CT imaging is an imaging

findings in non-traumatic Nasuda Danchaivijitr, Jan 2004 to Dec instrument for early
hemorrhagic stroke Yongchai Nilanont, 2005 identification of
Niphon Poungvarin hemorrhagic stroke patients
and providing imaging
evidence of high mortality
risk.

Cranial Noncontrast Alok Maheshwari, Indian Journal of It has the advantages of

Computed Tomography in Bindu Agrawal, A Public Health wide availability, short
Acute Cerebrovascular Sandeep, SK Sharma, Research & acquisition time and a high
Stroke, with Special Anupam Varshney Development 8 (1), sensitivity for identification
Reference to Circadian 2017 of intracranial hemorrhage
Variation in Stroke.

Intracerebral/subarachnoid MH Harirchian, N Cerebrovasc Dis 27 67 patients included; 32

haemorrhage and venous Mohsenzadeh, M (6), 1-241, 2009 suffered only stroke/TIA-
diseases Ghaffarpour symptoms, 21 only altered
level of consciousness and
14 both
 CHAPTER - 3

AIM AND OBJECTIVE

3.1 Aim

Role of mdct in evaluation of different types Haemorrhages stroke in brain special in old

age patient

3.2 Objective

Identify the most common causes of hemorrhagic stroke and the most common site of

the bleeding

3.3 Different types Haemorrhages

Cerebrovascular accident (CVA), otherwise called a stroke, is the third major cause of

morbidity and mortality in many developed countries. Stroke can be either ischemic or

hemorrhagic. Ischemic stroke is due to the loss of blood supply to an area of the brain. It

is a common type of stroke.

Hemorrhagic stroke is due to bleeding into the brain by the rupture of a blood vessel.

Hemorrhagic stroke may be further subdivided into intracerebral hemorrhage (ICH) and

subarachnoid hemorrhage (SAH). ICH is bleeding into the brain parenchyma, and SAH is

bleeding into the subarachnoid space. Hemorrhagic stroke is associated with severe

morbidity and high mortality. Progression of hemorrhagic stroke is associated with worse

outcomes. Early diagnosis and treatment are essential given the usual rapid expansion of

hemorrhage, causing sudden deterioration of consciousness and neurological

dysfunction.
 Fig 3.1 types of hemorrhage

3.4 Etiology

Hypertension is the most common cause of hemorrhagic stroke.

 Longstanding hypertension produces degeneration of media, breakage of the

elastic lamina, and fragmentation of smooth muscles of arteries.

 Lipohyalinosis, fibrinoid necrosis of the subendothelium, microaneurysms, and

focal dilatations are seen in the arterioles. The microaneurysms are named as

Charcot-Bouchard aneurysms.

 The common sites of hypertension-induced intracerebral hemorrhage are the

small penetrating arteries originating from basilar arteries or the anterior, middle,

or posterior cerebral arteries.

 Small artery branches of 50 to 700 μm in diameter often have multiple sites of

rupture associated with layers of platelet and fibrin aggregates.

 Hypertensive change causes non-lobar intracranial hemorrhage (ICH). As seen in

eclampsia, acute hypertension can also cause ICH, known as postpartum ICH.
Cerebral amyloid angiopathy (CAA) is an important cause of primary lobar intracerebral

bleeding in older adults.

 It is characterized by the deposition of the amyloid-β peptide in the capillaries,

arterioles, and small- and medium-sized arteries in the cerebral cortex,

leptomeninges, and cerebellum.

 This causes ICH in older adults, commonly associated with variations in the gene

encoding apolipoprotein E.

 A familial syndrome can occur in young patients, typically associated with

mutations in the gene encoding amyloid precursor protein.

 The incidence of CAA increases with age to the extent that around 50% of those

aged more than 70years have CAA. Recurrent hemorrhages can occur due to

CAA.

Other Important Risk Factors

 Cigarette smoking and moderate or heavy alcohol consumption, and chronic

alcoholism are significant risk factors.

 Chronic liver disease also increases the chance of ICH due to coagulopathy and

thrombocytopenia.

 Decreased low-density lipoprotein cholesterol and low triglycerides are also risk

factors.

 Dual antiplatelet therapy has an increased risk of ICH than monotherapy.

 Sympathomimetics such as cocaine, heroin, amphetamine, ephedrine, and

phenylpropanolamine carry an increased risk of a cerebral hemorrhage.

 Cerebral microbleeds (CMBs) associated with hypertension, diabetes mellitus,

and cigarette smoking increase the risk of ICH.

 Old age and male sex. The incidence of ICH increases after 55 years of age. The

relative risk after 70 years is 7.

 The tumors which are more prone to bleed are glioblastoma, lymphoma,

metastasis, meningioma, pituitary adenoma, and hemangioblastoma.

  The usual causes of spontaneous subarachnoid hemorrhage (SAH) are ruptured

aneurysm, arteriovenous malformation, vasculitis, cerebral artery dissection,

dural sinus thrombosis, and pituitary apoplexy. The risk factors are hypertension,

oral contraceptive pills, substance abuse, and pregnancy.

Intracranial hemorrhage of pregnancy (ICHOP-intracerebral or subarachnoid hemorrhage)

occurs with eclampsia. It is due to the loss of cerebrovascular autoregulation.

 CHAPTER – 4

Materials and Methods

4.1 Methods

MDCT (Multi – Detector computed tomography) utilizes multiple detectors to capture

images of the brain from various angles, resulting in high-resolution, detailed images. This

allows for the detection and differentiation of different types of hemorrhages, such as

intracerebral, subdural, and subarachnoid hemorrhages, as well as ischemic strokes.

4.2 Materials

MDCT ( Multi – Detector computed tomography) requires contrast agents to enhance the

visualization of blood vessels and perfusion patterns within the brain. These contrast

agents are typically administered intravenously. Additionally, MDCT may utilize advanced

imaging techniques such as perfusion imaging and CT angiography to assess blood flow

and vascular anatomy.

 CHAPTER- 5

RESULTS

SL
No Ag Se
. Name e x History Result
1 Kantilata Sahoo 65 F ? CVA Acute ICH with surrounding edemain right Lentiform nucleus
2 Tilotama Parida 60 F HTN Intraventricular Hemorrhage
3 Syed Maabud 56 M ? CVA Left badal gangila hemorrhage surrounding by edema
Hari mohan Convulsion
4 Tripathy 61 M s disorder left gangliothalamic hemorrhage
Susama
5 Samantaray 92 F HTN left basal ganglia hemorrhage
6 Phula Behera 58 F ? CVA Intraventricular hemorrhage
7 Urmila Prusty 69 F ? CVA Left basal ganglia hemorrhage
8 Sridhar Rout 56 M HTN Left gangliocapsular hemorrhage
9 Dhusasana Parida 72 M Old CVA Left capsulo - ganglionic acute hematoma
10 Rama ch Kandi 55 M ? CVA Left basal ganglia hemorrhage surrounded by edema
11 Bauria Arish 75 M ? CVA Right gangliocapsular and thalamic hemorrhage, intraventricular hemorrhage
Convulsion
12 Sarita Hansda 90 F s disorder Intraparenchymal hematoma
13 Lata Pradhan 75 F ? CVA Intracerebral hemorrhage
Convulsion
14 Kumari Sahoo 65 F s disorder Left gangliothalamic hemorrhage with extension to ventricles
15 Lata Bhoi 80 F HTN Intraparenchymal hematoma
Anirudha
16 Mohapatra 65 M ? CVA Left thalamic hemorrhage with extension to ventricles
Convulsion
17 Dipu Nayak 70 M s disorder Intracerebral hemorrhage
18 Ramesh Mohanty 85 M Old CVA Intraventricular hemorrhage
19 Sabita Parida 62 F ? CVA Right gangliocapsular and thalamic hemorrhage
20 Rajalaxmi Behera 67 F ? CVA Intracerebral hemorrhage