Blood can cause serious problems in a head trauma. A head CT can identify if there is blood in the brain (intraaxial lesions), around the brain (extraaxial hematomas), or in the cisterns and ventricles. A head CT is useful for evaluating size, signs/symptoms, shifts in midline structures, side, and site of extraaxial hematomas. It can also identify fractures and pneumocephalus. Understanding head CT anatomy is important for properly evaluating head trauma.

1. Reading a Head CT (Trauma)Daniel Weingrow D.O.

2. OverviewWho shouldn’t get a Head CT?Who should get a Head CT?How a CT is bornAnatomyBlood Can Be Very Bad5 S’s Extra-Axial HematomaEasy to Miss LesionsCases

3. Main PointBlood Can Be Very BadBCBVB

4. Main PointBlood Can Be Very BadBloodCBVB

5. Main PointBlood Can Be Very BadBloodCisternsBVB

6. Main PointBlood Can Be Very BadBloodCisternsBrainVB

7. Main PointBlood Can Be Very BadBloodCisternsBrainVentriclesB

8. Main PointBlood Can Be Very BadBloodCisternsBrainVentriclesBone and Soft Tissue

9. No CT?... If you don’t have a neurosurgeon

10. No CT?Radiation / Malignant Cancer – (VOMIT)Cognitive declineCost $300-600SedationTime in ER

12. Risk of Cancer 1:1000

14. Who to CT?AdultsNOCNEXUS IICanadian Head CT RulePediatricsKupperman

19. How a CT scan is made

20. Not true sagittal cuts – parallel to base of skull

21. Mathematically constructed digital image(Not a direct radiographic image)

22. Radiographic Densities = Hounsfield Units

23. CT can discriminate tissue density to a greater detail than can be displayed on single gray scale Brain Blood Bone Window Window Window

24. Volume Averaging Artifact

25. Motion Artifact

26. Beam hardening (low frequency absorbed) -> Streak Artifact

27. Neuroanatomy!

28. OrientationOrbitsPetrous portion of temporal boneSylvian fissure

29. The Coffee Bean

30. The Worms

31. Mr. Sad

32. Mr. Happy

33. The Heart

34. The Star

35. The X

36. Blood Can Be Very Bad

37. HU of Blood, Fluid properties of blood

38. BloodIntraaxialCortical ContusionBrain stem/ Deep InjuryDAIIVHSAH - sulciExtraaxialSDH – crosses sutureEDH – crosses falx and tent

39. Cortical Contusion

40. Hemorrhage + edema of gyri from bone impact

42. DAI

43. Extra-Axial Hematomas

45. Normal CT scan

46. How old?

47. 5S’s of Extra Axial - HematomaSize – #slices (each slice 0.5cm thick), measureSigns and SymptomsShifts and Serious Consequences (of ICP)Side – view from patients toesSite

48. Blood Can Be Very BadCisterns

49. Flow of CSF

50. Flow of CSFQuadrigeminal plate cSuperior CellabellarcCisterna MagnaPerimesencephaliccInterpeduncularcPrepontinecSupracellarc

51. Mr. Happy

52. The Heart

53. The Star

54. The X

55. Blood Can Be Very BadBrain

56. BrainGW interfaceIntraaxial and extra-axial lesionsGyri tight?

57. Blood Can Be Very BadVentricles – less ventricles = more problems

58. VentriclesMidline Shift Septum PellicidumJuan Valdez SignCerebral AqueductHydrocephalusEx vacouCommunicatingNon-communicatingRespect the Fourth

59. Midline Shift

60. Juan Valdez Sign

61. Hydrocephalus

62. Please Communicate!

63. Big Ventricles but… Hydrocephalus ex vacuo

64. Respect the Fourth

65. The Star

66. Respect the Fourth

67. Blood Can Be Very BadBone and Soft Tissue

68. Bone and Soft TissueIdentify Coup, Contra-coupBasilar Skull FracturePneumocephalus – base or open fxSphenoid Sinus, Ethmoid Sinus, Mastoid Air CellsFacial Trauma

69. Coup - Scalp

70. You won’t see this

71. Clinical Signs – Basilar Skull Fracture1234

72. PneumocephalusCan also be caused by open skull fx

73. Check the sinuses/ Facial Trauma

74. OverviewWho shouldn’t get a Head CT?Who should get a Head CT?How a CT is bornAnatomyBlood Can Be Very Bad5 S’s Extra-Axial HematomaEasy to Miss LesionsCases