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Head CT Basics : Trauma Micelle Haydel, MD LSU-New Orleans.

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Presentation on theme: "Head CT Basics : Trauma Micelle Haydel, MD LSU-New Orleans."— Presentation transcript:

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2 Head CT Basics : Trauma Micelle Haydel, MD LSU-New Orleans

3 First, a little test…

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13 Head CT Interpretation the basics

14 A Little History... In the early 1970s, Hounsfield developed a way of computerizing Xrays to select certain densities for viewing. –Plain films: black, white or a few shades of grey –CT: thousands of shades of grey based on the density of the tissue (Hounsfield Units)

15 What We Need to Know Air is very black (less than -300 HU) Water/CSF is black (near 0 HU) Bone is very dense/white ( HU) Blood is white (60-80 HU) Brain is gray HU

16 Quad 3rd Before we look at abnormal, A little normal geography: Use the Cisterns& Ventricles as landmarks 4th Supra

17 4th Ventricle

18 Suprasellar Cistern

19 Sella turcica Suprasellar

20 3 rd Ventricle Quadrigeminal Cistern

21 Temporal Horn of Lateral Ventricle

22 3 rd Ventricle & Quadrigeminal Cistern

23 Lateral Ventricles Frontal Occipital

24 Lateral Ventricles

25 4th Quad 3rd Suprasellar Review: Temp Horn

26 Normal Head

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38 ABNORMAL CTs

39 On each brain slice look for:  Symmetry, symmetry, symmetry sulci cisterns and ventricles grey-white differentiation

40 Identify What Doesn’t Belong Hyperdensities (whiter) extra-axial hematomas (SDH, EDH) ICB or contusion SAH in sulci, cisterns or ventricles Hypodensities (darker) pneumocephaly (air is darker than CSF) infarction

41 Identify What Doesn’t Belong Localized or diffuse edema effacement of sulci or cisterns distortion of gray-white matter interface enlarged ventricles, temporal horn Fractures soft tissue swelling fluid (blood) in sinuses or mastoid air cells in children, look for widened sutures Always look at bone windows

42 Blood: Acute blood is white (60-80 HU) on CT, due to the density of hemoglobin. As hgb breaks down, the HU decrease (i.e. subacute and isodense hematomas)

43 Dura mater Arachnoid Pia mater Dura tightly adhered to skull, but loosely to brain.

44 Epidural Hematoma -Lens shaped (dura tightly adhered to skull -Can cross midline -Frequently assoc. with fracture

45 Small Epidural Hematoma

46 Very Small Epidural Hematoma

47 Epidural with fracture

48 Very Small Epidural Hematoma with fracture

49 Epidural with Pneumocephaly

50 Subdural Hematoma Follows the contour of the brain & doesn’t cross the midline

51 Small SDH tracking down midline

52 Small Subdural Hematoma

53 Very Small Subdural Hematoma

54 Large Subdural Hematoma with shift

55 Isodense Subdural Hematoma

56 Hygroma with shift s/p SDH

57 Acute on Chronic Subdural Hematoma

58 Intraparenchymal Bleed

59 Intraparenchymal Bleed & Skull Fracture

60 Intraparenchymal Bleed & Contusions

61 Contusion

62 Pneumocephaly and contusion

63 Subarachnoid hemorrhage- Blood in the 4 th Ventricle

64 Subarachnoid blood in the suprasellar cistern

65 Subarachnoid blood tracking along the sulci

66 Intra-Ventricular Blood throughout

67 Subdural hematoma Temporal Horn enlargement

68 Epidural Enlarged Temporal Horn

69 Diffuse Edema, SAH tracking across tentorium

70 Subfalcean herniation (midline shift) due to SDH

71 Uncal herniation (EDH & subfalcean herniation)

72 Diffuse Edema s/p SAH

73 Soft-tissue swelling Fracture

74 ….the results

75 1. Epidural Hematoma

76 2. Skull Fracture SAH

77 3. Cerebral Contusion

78 4. SAH

79 5. Subdural Hematoma Subfalcean Herniation

80 6. Epidural Hematoma

81 7. Diffuse Edema

82 8. Isodense Subdural

83 9. Subdural Hematoma

84 ?


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