An 84-year-old male nursing home resident presented with increasing drowsiness and confusion over the past two weeks. A CT scan showed a left-sided low density subdural collection with a high density area, and midline shift to the left. The radiological diagnosis was acute on chronic subdural haemorrhage.

1. BRAIN CT REVISION
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ChanYon Quan

2. 5 Basic Densities
 Air
 Fat
 Soft tss / Fluid
 Calcium
 Metal
HYPODENSE
•Air
•Fat
•CSF
ISODENSE
•Brain tss
•Subacute SDH
HYPERDENSE
•Blood
•Iodine contrast
•Calcium
•Metal

3. An 84 year old male nursing home
resident presents with increasing
drowsiness.The care assistant who
attended with him informs you he has
become increasingly unsteady and
confused over the past two weeks
since falling in the bathroom and has
deteriorated rapidly over the past 24
hours. CT scan was performed and is
shown here.
1. What is in this CT scan?
Left -sided low density subdural collection with an area of high density within.
Midline shift to the left with effacement of sulci and the right lateral ventricle.
2. What is the radiological diagnosis?
Acute on Chronic Subdural haemorrhage

4. A 46 year old male with known
Adult Polycystic Kidney Disease
(APKD) presents to his GP with
sudden onset headache
associated with nausea and
vomiting.
1. What is the diagnosis?
SAH
2. What does his CT scan
show?What complication is
he developing?
Ruptured aneurysm
Blood in the subarachnoid spaces
Hydrocephalus – enlarged temporal
horns of the lateral ventricle
3. In which part of circle of Willis his aneurysm arose from?
Anterior communicating artery (ACOM)

5. A 24 year old female fell from her
horse during a cross country
competition, hitting her head on a
wooden fence on the way to the
ground. She was taken by
ambulance to A&E where on
examination she had a Glasgow
coma scale of 11/15. CT scan is
shown here..
1. Describe the two radiological abnormalities shown.
Soft tissue swelling over the right parietal bone
Right sided hyper-dense eliptical area
2. Give a radiological diagnosis.
Acute EDH
3. What other abnormalities should always be looked for in EDH?
Skull fracture- 80+% of EDH are associated with a skull fracture

6. Pneumocephalus – Mount Fuji sign