Head ct

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Head ct

  1. 1. Reading a Head CT (Trauma)<br />Daniel Weingrow D.O.<br />
  2. 2. Overview<br />Who shouldn’t get a Head CT?<br />Who should get a Head CT?<br />How a CT is born<br />Anatomy<br />Blood Can Be Very Bad<br />5 S’s Extra-Axial Hematoma<br />Easy to Miss Lesions<br />Cases<br />
  3. 3. Main Point<br />Blood Can Be Very Bad<br />B<br />C<br />B<br />V<br />B<br />
  4. 4. Main Point<br />Blood Can Be Very Bad<br />Blood<br />C<br />B<br />V<br />B<br />
  5. 5. Main Point<br />Blood Can Be Very Bad<br />Blood<br />Cisterns<br />B<br />V<br />B<br />
  6. 6. Main Point<br />Blood Can Be Very Bad<br />Blood<br />Cisterns<br />Brain<br />V<br />B<br />
  7. 7. Main Point<br />Blood Can Be Very Bad<br />Blood<br />Cisterns<br />Brain<br />Ventricles<br />B<br />
  8. 8. Main Point<br />Blood Can Be Very Bad<br />Blood<br />Cisterns<br />Brain<br />Ventricles<br />Bone and Soft Tissue<br />
  9. 9. No CT?... If you don’t have a neurosurgeon<br />
  10. 10. No CT?<br />Radiation / Malignant Cancer – (VOMIT)<br />Cognitive decline<br />Cost $300-600<br />Sedation<br />Time in ER<br />
  11. 11.
  12. 12. Risk of Cancer 1:1000<br />
  13. 13.
  14. 14. Who to CT?<br />Adults<br />NOC<br />NEXUS II<br />Canadian Head CT Rule<br />Pediatrics<br />Kupperman<br />
  15. 15.
  16. 16.
  17. 17.
  18. 18.
  19. 19. How a CT scan is made<br />
  20. 20. Not true sagittal cuts – parallel to base of skull<br />
  21. 21. Mathematically constructed digital image(Not a direct radiographic image)<br />
  22. 22. Radiographic Densities = Hounsfield Units<br />
  23. 23. CT can discriminate tissue density to a greater detail than can be displayed on single gray scale<br /> Brain Blood Bone<br /> Window Window Window <br />
  24. 24. Volume Averaging Artifact<br />
  25. 25. Motion Artifact<br />
  26. 26. Beam hardening (low frequency absorbed) -> Streak Artifact<br />
  27. 27. Neuroanatomy!<br />
  28. 28. Orientation<br />Orbits<br />Petrous portion of temporal bone<br />Sylvian fissure<br />
  29. 29. The Coffee Bean<br />
  30. 30. The Worms<br />
  31. 31. Mr. Sad<br />
  32. 32. Mr. Happy<br />
  33. 33. The Heart<br />
  34. 34. The Star<br />
  35. 35. The X<br />
  36. 36. Blood Can Be Very Bad<br />
  37. 37. HU of Blood, Fluid properties of blood<br />
  38. 38. Blood<br />Intraaxial<br />Cortical Contusion<br />Brain stem/ Deep Injury<br />DAI<br />IVH<br />SAH - sulci<br />Extraaxial<br />SDH – crosses suture<br />EDH – crosses falx and tent<br />
  39. 39. Cortical Contusion<br />
  40. 40. Hemorrhage + edema of gyri from bone impact <br />
  41. 41.
  42. 42. DAI<br />
  43. 43. Extra-Axial Hematomas<br />
  44. 44.
  45. 45. Normal CT scan<br />
  46. 46. How old?<br />
  47. 47. 5S’s of Extra Axial - Hematoma<br />Size – #slices (each slice 0.5cm thick), measure<br />Signs and Symptoms<br />Shifts and Serious Consequences (of ICP)<br />Side – view from patients toes<br />Site<br />
  48. 48. Blood Can Be Very Bad<br />Cisterns<br />
  49. 49. Flow of CSF<br />
  50. 50. Flow of CSF<br />Quadrigeminal plate c<br />Superior Cellabellarc<br />Cisterna Magna<br />Perimesencephalicc<br />Interpeduncularc<br />Prepontinec<br />Supracellarc<br />
  51. 51. Mr. Happy<br />
  52. 52. The Heart<br />
  53. 53. The Star<br />
  54. 54. The X<br />
  55. 55. Blood Can Be Very Bad<br />Brain<br />
  56. 56. Brain<br />GW interface<br />Intraaxial and extra-axial lesions<br />Gyri tight? <br />
  57. 57. Blood Can Be Very Bad<br />Ventricles – less ventricles = more problems<br />
  58. 58. Ventricles<br />Midline Shift Septum Pellicidum<br />Juan Valdez Sign<br />Cerebral Aqueduct<br />Hydrocephalus<br />Ex vacou<br />Communicating<br />Non-communicating<br />Respect the Fourth<br />
  59. 59. Midline Shift<br />
  60. 60. Juan Valdez Sign<br />
  61. 61. Hydrocephalus<br />
  62. 62. Please Communicate! <br />
  63. 63. Big Ventricles but… Hydrocephalus ex vacuo<br />
  64. 64. Respect the Fourth<br />
  65. 65. The Star<br />
  66. 66. Respect the Fourth<br />
  67. 67. Blood Can Be Very Bad<br />Bone and Soft Tissue<br />
  68. 68. Bone and Soft Tissue<br />Identify Coup, Contra-coup<br />Basilar Skull Fracture<br />Pneumocephalus – base or open fx<br />Sphenoid Sinus, Ethmoid Sinus, Mastoid Air Cells<br />Facial Trauma<br />
  69. 69. Coup - Scalp<br />
  70. 70. You won’t see this<br />
  71. 71. Clinical Signs – Basilar Skull Fracture<br />1<br />2<br />3<br />4<br />
  72. 72. Pneumocephalus<br />Can also be caused by open skull fx<br />
  73. 73. Check the sinuses/ Facial Trauma<br />
  74. 74. Overview<br />Who shouldn’t get a Head CT?<br />Who should get a Head CT?<br />How a CT is born<br />Anatomy<br />Blood Can Be Very Bad<br />5 S’s Extra-Axial Hematoma<br />Easy to Miss Lesions<br />Cases<br />

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