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Intra Cranial Hematoma
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Intra Cranial Hematoma

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Transcript

  • 1. Imaging in head injury
  • 2. X-ray
    • Detect skull fractures
    • Include neck in coma
    • Role is limited
  • 3. CT scan
    • Rapid
    • Non invasive
    • Bony & soft tissue injury
    • Site
  • 4. CT
    • Nature
    • Midline shifts
    • Mass effect
    • Presence of FB & air
  • 5. Disadvantages
    • Vascular lesions missed
    • Artefacts
    • Vertex fractures missed
    • Motion can degrade images
  • 6. Indications
    • Coma
    • No improvement
    • Falling GCS
    • Depressed skull fractures
    • Post traumatic seizures
  • 7. Indications for serial CT
    • Resolution of small hematomas
    • Delayed hematomas
    • Post traumatic changes
    • Immediate post operative - baseline
  • 8. MRI
    • Vascular lesions – aneurysm, ccf
    • Brain stem injuries
    • Axonal injuries
    • Contusions, small hematomas
  • 9. Disadvantages
    • Expensive
    • Longer imaging time
    • Fractures not well seen
    • SAH not well seen
  • 10. Others
    • EEG- seizure focus, brain death
    • Ventriculography – CSF loculation ,cysts
    • Angiography – vascular lesions
  • 11. Indications of CT in head injury
    • Skull fracture with
    • confusion & altered LOC
    • FND
    • seizures
  • 12. Indications of CT in head injury
    • Without skull fracture
    • persistent confusion
    • impaired LOC after resuscitation
  • 13. Indications of CT in head injury
    • Deteriorisation of LOC
    • Depressed skull fractures
    • Penetrating / open skull fractures
    • Uncertain diagnosis
    • Tense frontanelle
  • 14. Intra cranial hematoma
  • 15. Acute SDH
  • 16. Source
    • Parasagittal bridging veins
    • They drain the surface to dural sinuses
    • Associated paranchymal injury
  • 17. SDH
    • Level of consciousness
    • Anisocoria
    • Motor deficit
  • 18. Anisocoria
    • Ipsilateral to pupillary dialatation
    • Opposite to motor deficit
  • 19. SDH
    • A/C
    • Sub a/c
    • c/c
  • 20. A/C
    • 2-3 days
    • Hyperdense in CT
    • c/f resemble a/c EDH
    • Common in young
  • 21. CT
    • Crescendic
    • Laculnar
    • concavoconvex
  • 22. Treatment
    • Conservative
    • Surgical
  • 23. conservative
    • Size 4mm shift, 8mm size
    • Site – temporal tip
    • GCS
  • 24. Surgery
    • Craniotomy
    • evacuation
  • 25. Sub a/c
    • 2-3 wks
    • Isodense
    • MRI
  • 26. C/C
    • Similar to mass lesion
    • Old age
    • May not remember injury
  • 27.
    • Less symptoms
    • Large lesion
    • Brain atrophy
  • 28. Investigation
    • CT
    • Hypodense lesion
  • 29. Treatment
    • Conservative
    • Surgery
  • 30. Surgery
    • Craniotomy
    • Burr hole

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