Neurotrauma Radiology

What is this?

Extradural haematoma

• Any patients• Usually high impact• Usually associated fracture• Arterial bleed – peels dura off skull under

pressure• Usually clinical deterioration <4 hours post

injury

What else?

• Thickness – in mm at widest point• Midline shift – in MM at most shifted point• Effacement of ventricles

What is this?

Subdural haematoma

• Older people• Often minor injury/shearing force (25% no

trauma Hx)• Brain shrinks with age, subdural veins under

some tension• Slow bleed – often present weeks-months

later• Dcreased LOC, headache, ataxia, cognitive

dysfunction, Motor deficit, aphasia

What else?

• Thickness/Midline shift/ventricles• Age: Acute <4 days, subacute 4-21 days,

Chronic >21 days

What is this?

Subarachnoid haemorrhage

• Can be traumatic, aneurysmal, hypertensive• Sudden onset severe headache +/- neurology• 80% from ruptured aneurysm• CTB is 100% sensitive in first 6 hours*

Can look like this

Or this

Or this

Don’t rule out an SAH by looking at the CT yourself

Help me Dr! my basal cisterns are effaced!