Radiology workshop - LT Kishore AEGIS 2020 Bhavani Manaswini Ma'am

1. • Presentation : Worst headache ever.
• On examination: Rapid loss of alertness is
noted. Patient becomes extremely drowsy.
• Patient Data
• AGE: 52 years
• GENDER: Male
• HISTORY OF HYPERTENSION SINCE 5 YRS

2. What should you get done
immediately?
CT BRAIN
MRI BRAIN
LUMBAR PUNCTURE

3. WRONG
CT BRAIN( Non contrast, within 6 hours)
MRI ( As the time goes on, this is more sensitive)
Lumbar Puncture( more than 6 hours)
TRY AGAIN

4. Non Contrast CT brain of the patient.
NORMAL
ABNORMAL
HINT

5. COMPARE WITH NORMAL
BACK TO QUESTION

6. What are the structures marked in
blue?
Normal Sylvian fissure
Hyperdense Sylvian fissure
HINT

7. Sylvian fissure
Blue arrows point to hyperdense slyvian fissures.
BACK TO QUESTION

8. Findings Marked are:
Normal Chiasmatic cistern
and prepontine cistern
•Hyperdense
chiasmatic/suprasellar and
prepontine cisterns.
HINT

9. Normal Cisterns on Non contrast CT
Brain
Location of
suprasellar cistern
Prepontine
cistern
BACK TO QUESTION

10. So, what is the CT brain suggestive of?
SUB ARACHNOID
HEMORRHAGE
INTRA PARENCHYMAL
HEMORRHAGE

11. WRONG
• It is a sub arachnoid haemorrhage because
Cisterns are a part of sub arachnoid space.
• Intra-Parenchymal hemorrhage is diffuse ,
hyperdense lesions are not seen only at
specific places.

12. NO FURTHER IMAGING IS
REQUIRED
CT ANGIOGRAM is needed.
Patient is elderly and also
Hypertensive. Bleed in such patients
doesn't require further imaging.
Why should I bother patient to get
further imaging?

13. CORRECT
CT ANGIOGRAM WAS DONE AND
Anterior communicating artery (Acom)
ANEURYSM RUPTURE WAS DETECTED
This ruptured aneurysm was treated by
surgical clipping.
Ordering CT Angiogram saved the
patient

14. WRONG- LOCATION OF BLEED IS
IMPORTANT
• Finding out the cause of Subarachnoid
hemorrhage is important.
• By not ordering CT Angiogram, you missed
Anterior communicating artery (Acom)
ANEURYSM RUPTURE and patient died.

15. Cisterns in sub arachnoid space
Compartments within the sub
arachnoid space where pia mater and
arachnoid membrane are not in close
approximation and form pools or
cisterns of csf. Roughly superior to
inferior, we have:
• pericallosal cistern ( at corpus
callosum)
•Cistern at lamina terminalis
•Chiasmatic or suprasellar cistern( at the
level of optic chiasm)
•Prepontine cistern( in front of pons).

17. How do you treat
Clipping Coiling