Imaging in Head Trauma

Imaging in Head Trauma

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Dr Joshua Lauder - Consultant Radiologist

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​Objectives

​1. Appearances of traumatic brain injury

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2. Learn how to scroll through a CT scan and manipulate the images

​Format

1. Quiz based presentation on Imaging in head trauma​​

​2. Practical CT ​viewing - Post DICOM

​3. Review of CT - Post DICOM

​27 y/o male

​Alleged assault with baseball bat

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​Glasgow coma score 12/15

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Eyes 3

Voice 4

Motor 5

Multiple Choice

What is the initial imaging modality used in head trauma?

• Head Ultrasound

• Skull x-ray

• CT with contrast

• CT without contrast

• MRI

​Head injury guidelines

• ​GCS less than 13

• ​GCS less than 15 two hours after injury

• ​Suspected open/depressed fracture

• Sign of basal skull fracture

• Post traumatic seizure

• ​Focal neurological deficit

• ​More than one episode of vomiting

Multiple Choice

Where is the haemorrhage?

• Intra cerebral

• Sub dural

• Extra dural

• Sub arachnoid

​Computed tomography

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• ​

​R

​L

​Multiplanar reformat

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​Hounsfield units

​Windowing

​Brain window

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​Bone window

​Scalp window

​Blood on CT

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​Extradural haemorrhage

Contrast

No contrast

No contrast

Contrast

​Extradural haemorrhage

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• ​

Multiple Choice

How does the middle meningeal artery enter the skull?

• Foramen ovale

• Foramen rotundum

• Carotid canal

• Foramen spinosum

​Meningeal compartments

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Multiple Choice

What type of haemorrhage?

• Subacute subdural

• Acute subdural

• Chronic subdural

• Sub arachnoid

• Intra cerebral

​Meningeal compartments

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​20 year old

80 year old

Aging subdural haemorrhage

​Aging subdurals

​Acute on Chronic

​Extra dural vs Sub dural

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​Extra dural

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​Sub dural

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​Sub dural

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​Extra dural vs Sub dural

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Multiple Choice

Where is the haemorrhage?

• Extra dural

• Sub dural

• Sub arachnoid

• Intra cerebral

​Meningeal compartments

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​CSF spaces

​MRI shows fluid (T2 sequence)

Subarachnoid haemorrhage

Normal comparison

Multiple Choice

Where is the haemorrhage?

• Extra dural

• Sub dural

• Sub arachnoid

• Intra cerebral

​Meningeal compartments

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​Direct impact - Coup

​Indirect injury - Contrecoup

DAI

​MRI - microhaemorrhage in DAI

Secondary effects of haemorrhage​

1. ​Brain herniation

2. Hydrocephalus​

​Brain herniation

​Hydrocephalus

Normal

Hydrocephalus

https://www.postdicom.com?Share=1f67848c-109b-4988-aafa-7f28b72782dc&Lang=0

​Password - anatomy