Neuro clinics 16 ct scan for icu settings
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Neuro clinics 16 ct scan for icu settings

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practical CT scan for ICU settings

practical CT scan for ICU settings

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Neuro clinics 16 ct scan for icu settings Neuro clinics 16 ct scan for icu settings Presentation Transcript

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