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CT scan in head and spine injuries

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Presentation on theme: "CT scan in head and spine injuries"— Presentation transcript:

1 CT scan in head and spine injuries
By : Dr Ahmed Mohammed Debes سایت جامع رادیولوژی

2 Brief history

3 Basic physics Hounsfield Units
tissue’s attenuation coefficient the ability to “block” X-rays. relatively constant mapped onto Hounsfield scale from –1000 (black) to (white). the brain tissue is the point of reference. Any tissue “whiter” than brain tissue is hyper dense while any tissue “blacker” than brain tissue is hypo dense Basic physics Image acquisition

4 What to look for in CT scan brain of a head trauma patient ?
I - Skull Fracture II – Pneumo-cephalus III - Hematoma IV - Cerebral Edema V - Herniation What to look for in CT scan brain of a head trauma patient ?

5 I - Skull Fracture I - Linear, non-depressed fracture
Look in head CT bone window I - Linear, non-depressed fracture I - Skull Fracture

6 II - Depressed fracture
Consider open when - Skin laceration over the fracture - Through par nasal sinuses, middle ear structures Surgical elevation in - Depressed > 5 mm and overlies motor or speech areas - Depressed > skull thickness Causes laceration of Dura, arachnoid and possible brain parenchyma

7 III - Diastatic fracture
Spreading of suture, 1-2 mm more than normal contralateral side May tear Dural venous sinus

8 IV - Basilar fracture Presentations
- CSF otorrhea, bruising over mastoid (Battle sign) - CSF rhinorrhea, bruising around the eyes (raccoon eyes)

9 II - Pneumocephalus Presence of air in the cranial cavity
Indicates communication between intracranial and extra cranial spaces complications: meningitis, CSF otorrhea or rhinorrhea II - Pneumocephalus

10 III - Hematoma I - Epidural Hematoma Source of bleeding
most commonly middle meningeal artery Don't cross sutures Hyper dense biconvex extra-axial mass III - Hematoma

11 II - Subdural Hematoma Source of bleeding torn cortical bridging veins
Can cross suture Can extend into interhemispheric fissure Hyper dense crescent blood collection

12 III - Traumatic Subarachnoid Hemorrhage
Source of bleeding Tear of veins in subarachnoid space High density blood in sulci/cisterns

13 IV - Cerebral Contusion
due to cerebral gyri impact inner table of the skull Evolve from petechial hemorrhage -> small hemorrhage ->large hematoma Multiple, bilateral MRI is better for detection

14 III - Cerebral Edema Generally resolves within 2 weeks
- loss of grey/white matter interface - compressed ventricles - effacement of the sulci III - Cerebral Edema

15 IV - Herniation I - Midline Shift & Subfalcine Herniation
Subfalcine herniation is herniation of Cingular gyrus underneath the falx cerebri. Presence of midline shift usually signify Subfalcine herniation, and vice versa. IV - Herniation

16 II - Transtentorial herniation
Central herniation is defined as both temporal lobes descend through the tentorial incisura Effacement of the cistern around the midbrain

17 III - Tonsillar Herniation
- obliteration of CSF space - displaced portions of cervicomedullary junction

18 I - Compression fracture
CT scan in spine trauma

19 II – Burst fracture

20 III – Flexion fracture

21 III – fracture dislocation

22 The end Thank you

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