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Neuro clinics - 16 Dr Pratyush Chaudhuri Sponsored by Mankind Pharmaceuticals
<ul><li>www.arnicainheadinjury.hpage.com </li></ul>
NEURO CT IN ICU Dr Pratyush Chaudhuri Supported by Nirmal Clinics
Why CT ?? <ul><li>Less scan time as compared to MRI </li></ul><ul><li>Easy availability </li></ul><ul><li>Patients on life...
Physics <ul><li>Prof Hounsfield  (British) </li></ul><ul><li>First CT machine made by Hitachi (Japan) </li></ul><ul><li>Ho...
CT Sectional Anatomy
Normal cerebral vascular anatomy
Common etiological classification I.  Intracranial haemorrhage  (traumatic & non-traumatic) II.  Infarct III. Infective IV...
I A.  Traumatic intracranial haemorrhage A. Subdural haemorrhage B. Extradural haemmorhage C. Subarachnoid haemorrhage D. ...
A. Subdural haemorrhage <ul><li>Between dura and arachnoid </li></ul><ul><li>Crosses sutures </li></ul><ul><li>Crescentic ...
B. Extradural haemorrhage <ul><li>Commonly associated with fracture </li></ul><ul><li>Biconvex shape </li></ul><ul><li>Dis...
Extradural haemorrhage Trauma with EDH & pneumocephalus
C. Subarachnoid haemorrhage <ul><li>a. Traumatic SAH </li></ul><ul><li>b. Non-traumatic SAH </li></ul><ul><li>seen in aneu...
D. Traumatic haemorrhagic    contusion <ul><li>Foci of punctate or linear haemorrhage </li></ul><ul><li>Common at grey-whi...
D.Traumatic haemorrhagic contusion Cerebral edema Multiple fractures
I b. Non-traumatic intracranial haemorrhage <ul><li>i)  Hypertensive haemorrhage </li></ul><ul><li>ii)  Haemorrhagic infar...
i) Hypertensive haemorrhage <ul><li>Common locations are: </li></ul><ul><li>Putamen / external capsule </li></ul><ul><li>T...
Hypertensive haemorrhage
Hypertensive encephalopathy <ul><li>Pre-eclampsia / eclampsia (Common site is  bilateral occipital region) </li></ul><ul><...
ii) Haemorrhagic Infarction <ul><li>Arterial Infarction </li></ul><ul><li>Venous Infarction </li></ul>
Arterial Haemorrhagic Infarct <ul><li>Common Cause of Haemorrhagic transformation is-  Embolism </li></ul>Post contrast Pl...
Venous Infarct <ul><li>Commonly associated with venous sinus thrombosis </li></ul><ul><li>Hyperdense sinus - Plain CT </li...
Venous Thrombosis OR ?? 50 year old lady with severe headache referred for CTA
iii) Aneurysms <ul><li>Commonest presenting symptom is SAH </li></ul><ul><li>Intra-ventricular breakthrough </li></ul><ul>...
iv) Vascular Malformation <ul><li>Arterio venous Malformation </li></ul><ul><li>Cavernous angioma </li></ul><ul><li>Venous...
Intra-ventricular bleed 35 year old man came with sudden loss of consciousness
Arterio-venous malformation CT Angiogram performed Axial Coronal Sagittal
Haemorrhagic Neoplasm <ul><li>Malignancy induced coagulopathy –Leukemia </li></ul><ul><li>Intra-tumoral bleed : Primary  <...
Intratumoral bleed <ul><li>Common tumors are: </li></ul><ul><li>-Pituitary adenoma </li></ul><ul><li>-GBM </li></ul><ul><l...
Bleed in GBM 45 yrs old lady operated for Ca breast ,presented with right sided weakness
Iatrogenic Intracerebral bleed Patient with MI – Post thrombolytic therapy, sudden loss of consciousness Bleed in right BG
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Neuro clinics 16 ct scan for icu settings

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practical CT scan for ICU settings

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Transcript of "Neuro clinics 16 ct scan for icu settings"

  1. 1. Neuro clinics - 16 Dr Pratyush Chaudhuri Sponsored by Mankind Pharmaceuticals
  2. 2. <ul><li>www.arnicainheadinjury.hpage.com </li></ul>
  3. 3. NEURO CT IN ICU Dr Pratyush Chaudhuri Supported by Nirmal Clinics
  4. 4. Why CT ?? <ul><li>Less scan time as compared to MRI </li></ul><ul><li>Easy availability </li></ul><ul><li>Patients on life supporting equipment which is a contraindication for MR </li></ul><ul><li>Post-operative debilitated patients </li></ul>
  5. 5. Physics <ul><li>Prof Hounsfield (British) </li></ul><ul><li>First CT machine made by Hitachi (Japan) </li></ul><ul><li>Hounsfield units (HU) - ranges from </li></ul><ul><li>- 1000 to +1000 </li></ul>
  6. 6. CT Sectional Anatomy
  7. 7. Normal cerebral vascular anatomy
  8. 8. Common etiological classification I. Intracranial haemorrhage (traumatic & non-traumatic) II. Infarct III. Infective IV. Congenital
  9. 9. I A. Traumatic intracranial haemorrhage A. Subdural haemorrhage B. Extradural haemmorhage C. Subarachnoid haemorrhage D. Haemorrhagic contusions
  10. 10. A. Subdural haemorrhage <ul><li>Between dura and arachnoid </li></ul><ul><li>Crosses sutures </li></ul><ul><li>Crescentic shape </li></ul><ul><li>Acute SDH- hyperdense </li></ul><ul><li>Chronic SDH-hypodense </li></ul>
  11. 11. B. Extradural haemorrhage <ul><li>Commonly associated with fracture </li></ul><ul><li>Biconvex shape </li></ul><ul><li>Displace grey-white matter interphase </li></ul><ul><li>Does not cross sutures </li></ul>
  12. 12. Extradural haemorrhage Trauma with EDH & pneumocephalus
  13. 13. C. Subarachnoid haemorrhage <ul><li>a. Traumatic SAH </li></ul><ul><li>b. Non-traumatic SAH </li></ul><ul><li>seen in aneurysm </li></ul><ul><li>rupture & hemorrhagic </li></ul><ul><li>venous infarct </li></ul><ul><li>c. High density fluid collection in superficial sulci & cisterns </li></ul>
  14. 14. D. Traumatic haemorrhagic contusion <ul><li>Foci of punctate or linear haemorrhage </li></ul><ul><li>Common at grey-white matter junction </li></ul>
  15. 15. D.Traumatic haemorrhagic contusion Cerebral edema Multiple fractures
  16. 16. I b. Non-traumatic intracranial haemorrhage <ul><li>i) Hypertensive haemorrhage </li></ul><ul><li>ii) Haemorrhagic infarction </li></ul><ul><li>iii) Aneurysm & vascular malformation </li></ul><ul><li>iv) Haemorrhagic neoplasm </li></ul><ul><li>v) Iatrogenic </li></ul>
  17. 17. i) Hypertensive haemorrhage <ul><li>Common locations are: </li></ul><ul><li>Putamen / external capsule </li></ul><ul><li>Thalamus </li></ul><ul><li>Pons </li></ul><ul><li>Cerebellum </li></ul><ul><li>Subcortical white matter </li></ul>
  18. 18. Hypertensive haemorrhage
  19. 19. Hypertensive encephalopathy <ul><li>Pre-eclampsia / eclampsia (Common site is bilateral occipital region) </li></ul><ul><li>Chronic renal failure </li></ul><ul><li>Thrombotic thromocytopenic purpura </li></ul><ul><li>Hemolytic uremic syndrome </li></ul><ul><li>SLE </li></ul>
  20. 20. ii) Haemorrhagic Infarction <ul><li>Arterial Infarction </li></ul><ul><li>Venous Infarction </li></ul>
  21. 21. Arterial Haemorrhagic Infarct <ul><li>Common Cause of Haemorrhagic transformation is- Embolism </li></ul>Post contrast Plain
  22. 22. Venous Infarct <ul><li>Commonly associated with venous sinus thrombosis </li></ul><ul><li>Hyperdense sinus - Plain CT </li></ul><ul><li>Empty delta sign- Contrast enhanced CT </li></ul>
  23. 23. Venous Thrombosis OR ?? 50 year old lady with severe headache referred for CTA
  24. 24. iii) Aneurysms <ul><li>Commonest presenting symptom is SAH </li></ul><ul><li>Intra-ventricular breakthrough </li></ul><ul><li>CT angiogram is helpful to demonstrate site of aneurysm </li></ul>CT Angiogram Post clipping bleed
  25. 25. iv) Vascular Malformation <ul><li>Arterio venous Malformation </li></ul><ul><li>Cavernous angioma </li></ul><ul><li>Venous angioma </li></ul><ul><li>Capillary telangectasia </li></ul>
  26. 26. Intra-ventricular bleed 35 year old man came with sudden loss of consciousness
  27. 27. Arterio-venous malformation CT Angiogram performed Axial Coronal Sagittal
  28. 28. Haemorrhagic Neoplasm <ul><li>Malignancy induced coagulopathy –Leukemia </li></ul><ul><li>Intra-tumoral bleed : Primary </li></ul><ul><li>: Metastatic </li></ul>
  29. 29. Intratumoral bleed <ul><li>Common tumors are: </li></ul><ul><li>-Pituitary adenoma </li></ul><ul><li>-GBM </li></ul><ul><li>-Oligodendroglioma </li></ul><ul><li>-Ependymoma </li></ul><ul><li>-PNET </li></ul><ul><li>-Mets : Lung, renal, choriocarcinoma, </li></ul><ul><li>melanoma </li></ul>
  30. 30. Bleed in GBM 45 yrs old lady operated for Ca breast ,presented with right sided weakness
  31. 31. Iatrogenic Intracerebral bleed Patient with MI – Post thrombolytic therapy, sudden loss of consciousness Bleed in right BG
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