Systematic Approach to Reading a Non-Contrast Head CT Scan

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Presentation transcript:

Systematic Approach to Reading a Non-Contrast Head CT Scan

Systematic Approach Assess each component of the intracranial cavity Blood Brain Bone CSF

Blood Epidural Hematoma (EDH) Subdural Hematoma (SDH) Arterial Bleed: High-Pressure “Lens” Shape Middle Meningeal Laceration (Skull Fracture) Subdural Hematoma (SDH) Venous Bleed: Low-Pressure “Crescent” Shape Acute / Chronic (Is Patient Anticoagulated? Alcoholic?) Subarachnoid Hemorrhage (SAH) Traumatic / Aneurysmal Intraventricular Hemorrhage (IVH) Intraparenchymal Hemorrhage (IPH) Hypertensive Basal Ganglia or Lobar Cerebral Contusion “Coup-Contrecoup”

EDH

SDH: Acute/Chronic

SAH (Aneurysmal)

IVH

IPH

IPH

Contusion Coup (Red) Contrecoup Contusion (Orange) (at 180 degrees)

Brain Symmetry (of Hemispheres) Hyper-/Hypodensities (Masses, Edema, Stroke) Grey/White Matter Border Lost Grey-White Differentiation in Anoxic Injury Midline Shift Gyri/Sulci Wide Sulci: Atrophy Effaced Sulci: Edematous “Tight/Swollen” Brain Pneumocephalus (Air in Brain) Open Fracture (or Craniotomy) Fracture through Sinus

Mass

Midline Shift

Sulci/Gyri: Atrophy/Edema

Bone Fractures Especially Temporal Bones Sinuses & Air Cells Look for Air-Fluid Levels

Pneumocephalus

Temporal Bone Fracture

CSF: Ventricles & Cisterns Blood in Ventricles? Effacement/Asymmetry: Compression from Mass/Hematoma Hydrocephalus Atrophy (“Ex Vacuo”) Communicating / Obstructive Hydrocephalus If Obstructive, Where? Look at Lateral, 3rd, and 4th Ventricles Cisterns Look for Effacement (Edema/Early Herniation) Look for Blood

Cisterns/Effacement

Ventricles/Hydrocephalus