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HEAD CT SCAN
Citation preview
by Nurhayani Dwi Susanti
Radiology Department - Zainoel Abidin Hospital
Banda Aceh - NAD
HEAD CT SCAN IMAGING
NORMAL 40 YEARS OLD
HEMORRHAGE
• INTRACRANIAL HEMORRHAGE – POSSIBLE LOCATION
Intraparenchymal
Intraventricular
Subarachnoid
Subdural / epidural
• INTRAPARENCHYMAL BLEEDING
location, location, location…
Hypertensive bleed – most common (80%)
Basal ganglia
Thalamus
Pons
Cerebellum
INTRAPARENCHYMAL BLEEDING
• Atypical locations like cerebral hemispheres
AVM
Aneurysm
Berry and mycotic
Trauma
Amyloid angiopathy
Tumor
Vascular mets, primary tumor
Vasculitis, coccaine, amphetamine, bleeding diathesis, anticoagulation, etc
Intraparenchymal bleed
CT – natural history
Accompanied by vasogenic edema, some mass effect
• Consider enhanced scan for mass effect out of proportion to size of hematoma
• Possibility of underlying tumor
Much later, thin slit of hypodensity is seen at site of bleed
DON’T BE FOOLED :
Normal Variant : calcification in the basal ganglia usually symmetric)
• Berry aneurysm
• Trauma
SUBARACHNOID HEMORRHAGE
SUBDURAL & EPIDURAL HEMATOMA
• Usually traumatic in origin
• Subdural
Venous bleed
Low pressure
Slow growth
• Epidural
Arterial bleed
High pressure
Rapid growth
• Both may be life-threatening from mass effect and herniation
• A collection of blood below the inner layer of the dura but external to the brain and arachnoid membrane
SUBDURAL HEMATOMA
• Underlying fracture
• A tearing of the middle meningeal artery
• Biconvex in shape
• Displacing the brain away from skull
EPIDURAL HEMATOMA
ACUTE SUBDURAL HEMATOMA
• Trauma
• Hypertension
• Aneurysm
INTRAVENTRICULAR HEMORRHAGE
QUIZ
THIS HEAD CT SCAN SHOWS….
WHAT IS THE TYPE OF HEMORRHAGE IN THIS PATIENT ?
a. Subdural hematoma
b. Epidural hematoma
c. Subarachnoid hemorrhage
d. Subgaleal hematoma
WHAT IS THE TYPE OF HEMORRHAGE ?
THIS HEAD CT SCAN SHOWS….
a. Acute subdural hematoma
b. Acute epidural hematoma
c. Chronic subdural hematoma
d. Chronic subgaleal hematoma
THIS PATIENT HAD ….
THIS HEAD CT SCAN SHOWS….
THIS HEAD CT SCAN SHOWS….
THANK YOU
• Cytotoxic
Grey and white matter
Wedge shape
Infarct
• Vasogenic
Almost exclusively in white matter tracts
Finger-like projections
Infection, XRT, tumor
DIFFERENTIATING CYTOTOXIC FROM VASOGENIC EDEMA
• Poor differentiation of gray from white matter
• No sulci visible
DIFFUSE CEREBRAL EDEMA