Common CT Head Findings and Interpretation Flashcards
Range of densities Air Water CSF White matter Grey matter Coag blood Bone
Air - black Water CSF White Grey Coag blood Bone - white
Introduction
-key things to include
Patient name, hospital no, DOB
Date, time of scan
Request previous scans
- Blood
Fresh blood - hyperdense
Old blood - hypodense
Extradural - between dura and skull
Subdural hematoma - between dura and subarachnoid
Subarachnoid hematoma - between arachnoid and pia
Intracerebral hemorrhage - into brain tissue
- Cisterns
4 cisterns
- Supracellar - around sella turcica
- Sylvian - come off anterolateral to supracellar
- Ambient - around midbrain, come off posteromedial to supracella
- Quadrigeminal - post to midbrain
Assessing for
- effacement
- blood
- asymmetry
- Brain
Sulcal effacement - loss of normal gyral sulci pattern from EDEMA
- hypoxic brain injury
- ischemic stroke
- tumour
- cerebral abscess
Midline shift
Hypodense foci - air, edema, fat
-edema often surrounds ICH, tumours, abscesses
Hyperdense foci - blood, thrombus, calcification
Tumour - may have -surrounding edeema -mass effect -surrounding bleed If contrast given -homogenous - highly vascular/meningioma -ring enhancement - abscess
- Ventricles
Normally hypodense
Hyperdensity within ventricle => intraventricular bleed
Hyperdensity within lateral ventricular wall => calcification of choroid plexus
Hydrocephalus - abnormal collection of CSF => dilation of ventricles
-communicating vs non communicating
Ventricular effacement - CSF shift from increased ICP
- Bone
Fractures
Extradural hematoma
- presentation
- CT findings
- investigations
- management
LOC => lucid period => rapid deterioration
- headache
- N+V
- confusion, reduced conciousness
- superficial evidence of head injury
Hx of trauma => MMA
- leaf shape + skull fracture
- sulcal effacement, midline shift
- ventricular effacement
Bedside -vital obs, cranial nerve exam -ECG Bloods -FBC, U&E, coagulation, glucose -G&S, INR - likely surgical intervention needed
Management
- A-E => urgent neurosurgery referral
- prophylactic ABx, anticonvulsants if needed, mannitol
Subdural hematoma
- presentation
- CT findings
- investigations
- management
Worsening headache, N+V, confusion => reduced LOC
Cranial nerve abnormalities
Hx of falls => torn bridging veins
- banana shape
- sulcal effacement
Bedside
-neuro obs, ECG
Bloods
-FBC, U&E => asess bleeding, electrolyte derangents
-coagulation, G&S => reverse any coagulopathies, prep for surgery
-glucose => can also present in a similar manner
A-E stabilisation
Correct coagulopathy
Analgesia
Neurosurgery referral
Subarachnoid hematoma
- presentation
- CT findings
- investigations
- management
Thunderclap headache => N+V, photophobia, neckstiffness, RLOC
Hx of trauma => bleed into CSF spaces
Can also be spontaneous from aneurysms/ADPKD
Bedside -neuro obs, ECG, cap glucose Bloods -FBC, U&E => baseline -coagulation, INR, G&S => reverse coagulopathies, prep for surgery Imaging -CT angio => locate bleed
A-E stabiliation
Nimodipine => prevent arterial vasospams
Analgesia
Urgent neurosurgery referral => coiling/clipping
Intracerebral hemorrhage
- presentation
- CT head findings
- investigations
- management
Bleed within the brain tissue
-area of hyperdensity within brain tissue
Sudden neuro focal deficit with background of HTN, headaches
Bedside
-Neuro, cranial nerve exam, ECG (cardiac injury)
-LP - rule out SAH
Bloods
-FBC, U&E => baseline
-glucose => rule out hyper/hypoglycemia for neuro deficits
-coagulation, INR, G&S => surgical intervention needed
Imaging
-CT angio - locate cause
A-E stabilisation
Analgesia, antiemetics
Reverse coagulopathy
Neurosurgery referral
Meningioma
- presentation
- CT head findings
- management
Gradual, subtle changes, signs depend on location of meningioma
- seizures - irritation of cortex
- focal/generalised neuro deficits
Well demarcated hyperdense lesion in periphery adhering to dura - dural tail
-may cause mass effect changes
Surgical excision
Criteria for CT head within 1 hr of risk factor identification
GCS U13 - on initial ED assessment GCS not 15 2hrs after injury Suspected open/depressed skull fracture Signs of basal skull fracture Focal neuro deficit Vomit 2+ Post traumatic seizure
