Common: 200 000 TC/an, 12 000 death Neuroimaging plays a critical role in the evaluation of patients with traumatic brain injury CT:  first-line of imaging MR imaging being recommended in specific settings MR imaging DTI, blood oxygen level–dependent fMRI, MR spectroscopy, perfusion imaging are of particular interest in identifying further injury CT and MRI are normal, as well as for prognostication in patients with persistent symptoms

1. TRAUMATICBRAININJURY
F. Benoudiba, JL Sarrazin

4. TRAUMATIC BRAIN INJURY AND
IMAGING
Accute management Chronic management
CT
-Bodyscan
-Hematoma
-CT Angiography
MRI
-PCF
-Cerebral Herniation
- Complications
MRI
-Staging
- Prognostication
- Complications
- Sequelae

5. Extra axial primitive lesion: Extra dural
Haemorrhage
Fast evolution
Located
dura mater
- Lucid interval (1 - 2 cases /3 )
• Typically associated with a skull
fracture
Surgical
Emergency
ICP

6. • Bi-convex in shape, hyperdense
• Limited by the cranial sutures
• Next a skull fracture
• Usually unilateral
• Mass effect
• Swirl sign: non clotted fresh
blood less hyperdense
Imaging features

7. • Mecanism:
• Usually No fracture
• Contre coup
Extra axial primitive lesion: Sub dural
Haemorrhage
Slow
evolution
High
mortality: ICP

8. • Don’t cross the dural sinus
falx cerebri tentorium
falx cerebelli
• SDH is not limited by sutures
Extra axial primitive lesion: Sub dural
Haemorrhage

9. Bilatéral
15%
Infant

10. Sub dural Haemorrhage
: polymorphism
Acute (unclotted blood) Sub acute: isodense Chronic: sub dural hygroma

11. • Less frequent
• -Cerebral sulci
• -
skull fractures cerebral
contusions
• Complications:
• -Communicating hydrocephalus
-Vascular vasospasm
Extra axial primitive lesion: Sub
arachnoid Haemorrhage
Worrying:
underlying arterial
dissection or an
aneurysmal
haemorrhage that
preceded trauma

12. • Usually contre coup lesions
• Small radius of curvature:
orbito-frontal, temporal,
temporo-basal
• Corpus callosum
• Pontine
Primitive intra-axial lesion: intra parenchymal
Haemorrage (contusion)
Oedema
Mix:
oedema+hemorrhage
Hemorrhage

13. Primitive intra-axial lesion: intra parenchymal
Haemorrage (contusion)
Oedema Mix Hemorrhage

14. Primitive intra-axial lesion: Axonal injury
High Energy
trauma+++
White and Gray
matter jonction
White ang Gray
mater
Corpus
callosum
Brainstem
Sévérité

15. T2 EG
SWI
Primitive intra-axial lesion: Axonal
injury MRI +++
T2 GE
SWI
Magnetic
susceptibility

16. Primitive intra-axial lesion:
Axonal injury

17. Primitive intra-axial lesion: Axonal
injury
Duret Hemorrhage :
Coma
Vegetative outcome

18. Complications
HTIC Vasculaire Hémorragie
secondaire
Chronique
EOP (hématoma,
œdema)
Ischemia (CPA+++,
ACA)
Duret Osteodural defect
Hydrocephalia AVF Cognitive
impairment
Oedema Dural sinus thrombosis Epilepsia
Cerebral herniation Dissection, thrombosis,
aneurysm
Hydrocephalia

19. Complication: Cerebral Oedema

20. Sulfalcine
Cingular
Temporal
Transtentorial
Tonsillar
Complication: Cerebral Herniation

21. Contralateral ventricular
dilatation
Pericallosal artery
ACA
Complication: Cerebral Herniation
Effacement of the basal cistern
Brainstem compression
Duret Haemorrhage
Tonsillar herniation
Tonsillar
Effacement of the basal
cistern
CPA
Transtentorial
Temporal
Sulfalcine
>5mm

22. Complication: vascular
-Ischémia
Dural thrombosis
-CCF-Aneurysm
-Dissection

23. Complication: infectious
Osteo-dural defect
T2 Ciss or FiestaCisternoCT

24. Complication: Cognitive impairment
F, 23 ans Mild traumatic brain injury
Contusion on MRI
Emotional, psychological, and social difficulties
DTI
Contrast based
on the
directional rate
of diffusion of
water molecules
(ADC and FA)

25. Complication: Cognitive impairment
Invisible lesions

26. FOT droit

27. Working Memory : 2,756 %Working Memory : 2,756 %
Connectomics is the
study of the brain
connectivity maps
Emerging approach
to study the brain as
a network of
interconnected brain
regions

28. To conclude