PCE CT head

Question 1

epidural hematoma

Answer 1

Usually happens with a skull fracture
The fractured bones lacerates a dural artery or venous sinus.
The blood from the vessel collects between the skull and the dura

Biconvex (Lemon) shaped

Almost always arterial

Usually cannot cross suture lines

Can cross falx cerebri

Does not cross into the cerebrum

Question 2

Subarachnoid haemorrhage

Answer 2

Injury to small arteries
The vessel bleeds between the pia and arachnoid matter
(occurs due to trauma or aneurysm)

Can cross suture lines but not falx cerebri

Does not extend into the cerebrum

Patient often presents with thunderclap headache

Blood enters the subarachnoid space, most commonly around the circle of willis and sylvian fissure

Can be traumatic but often from ruptured aneurysm (~80%)

Blood contained to ‘gaps’ in the cerebrum

Question 3

Subdural hematoma

Answer 3

Blood gathers with the outermost meninges layer
between the dura matter, which adheres to the skull
and the the arachnoid matter, which envelopes the brain

Blood pools between the dura mater and arachnoid mater

Mostly traumatic, but can rarely be spontaneous

Primarily Venous

Usually convex/crescent moon shaped

Can cross suture lines but not falx cerebri

Does not extend into the cerebrum

Question 4

hydrocephalus

Answer 4

A
A problem with the production of CSF to its re-absorption (more often in children)
congenital hydrocephalus – hydrocephalus that’s present at birth
acquired hydrocephalus – hydrocephalus that develops after birth (injury or illness e.g brain tumour)
normal pressure hydrocephalus – usually only develops in older people

Question 5

Intracerebral/Intraparenchymal haemorrhage
Causes
Location
Prognosis

Answer 5

Usually non traumatic, due to aneurysm/AV malformation rupture. More common in anticoagulated patients

Can also be associated with stroke

Blood seen within the brain tissue itself

Often causes mass effect

Within the brain so not contained by meninges

Very poor prognosis

Question 6

What is mass effect

Answer 6

Shift of the brain to one side due to presence of mass/fluid

Use the falx cerebri to determine the midline position and assess deviation

Question 7

Another name for epidural

Answer 7

Extradural

Question 8

Structure of a head CT PCE

Answer 8

Shape and size of pathology
Attenuation/opacity
Location
Effacement/mass effect
Any soft tissue or bone abnormalities

Name the pathology if you are sure (not needed for full marks)
Beware: if you get this wrong, you lose all marks.