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practical CT scan for ICU settings
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Neuro clinics - 16
Dr Pratyush Chaudhuri
Sponsored by Mankind Pharmaceuticals
www.arnicainheadinjury.hpage.com
NEURO CT IN ICU
Dr Pratyush Chaudhuri
Supported by Nirmal Clinics
Why CT ??
Less scan time as compared to MRI
Easy availability
Patients on life supporting equipment
which is a contraindication for MR
Post-operative debilitated patients
Physics Prof Hounsfield (British)
First CT machine made by Hitachi (Japan)
Hounsfield units (HU) - ranges from
- 1000 to +1000
CT Sectional Anatomy
Normal cerebral vascular anatomy
Common etiological classification
I. Intracranial haemorrhage
(traumatic & non-traumatic)
II. Infarct
III. Infective
IV. Congenital
I A. Traumatic intracranial haemorrhage
A. Subdural haemorrhage
B. Extradural haemmorhage
C. Subarachnoid haemorrhage
D. Haemorrhagic contusions
A. Subdural haemorrhage
Between dura and arachnoid
Crosses suturesCrescentic shapeAcute SDH-
hyperdenseChronic SDH-
hypodense
B. Extradural haemorrhage
Commonly associated
with fracture
Biconvex shape
Displace grey-white
matter interphase
Does not cross sutures
Extradural haemorrhage
Trauma with EDH & pneumocephalus
C. Subarachnoid haemorrhage
a. Traumatic SAH
b. Non-traumatic SAH seen in aneurysm rupture & hemorrhagic venous infarct
c. High density fluid collection in superficial sulci & cisterns
D. Traumatic haemorrhagic contusion
Foci of punctate or linear haemorrhage Common at grey-white matter junction
D.Traumatic haemorrhagic contusion
Cerebral edema
Multiple fractures
I b. Non-traumatic intracranial haemorrhage
i) Hypertensive haemorrhage
ii) Haemorrhagic infarction
iii) Aneurysm & vascular malformation
iv) Haemorrhagic neoplasm
v) Iatrogenic
i) Hypertensive haemorrhage
Common locations are:
• Putamen / external capsule• Thalamus• Pons • Cerebellum• Subcortical white matter
Hypertensive haemorrhage
Hypertensive encephalopathy
Pre-eclampsia / eclampsia (Common site is bilateral occipital region)
Chronic renal failureThrombotic thromocytopenic purpuraHemolytic uremic syndromeSLE
ii) Haemorrhagic Infarction
Arterial Infarction
Venous Infarction
Arterial Haemorrhagic Infarct
Common Cause of Haemorrhagic transformation is- Embolism
Post contrastPlain
Venous Infarct
Commonly associated with venous sinus thrombosis
Hyperdense sinus - Plain CT Empty delta sign- Contrast enhanced CT
Venous Thrombosis OR ??
50 year old lady with severe headache referred for CTA
iii) Aneurysms
Commonest presenting symptom is SAH
Intra-ventricular breakthrough
CT angiogram is helpful to demonstrate site of aneurysm
CT Angiogram
Post clipping bleed
iv) Vascular Malformation
Arterio venous Malformation
Cavernous angioma
Venous angioma
Capillary telangectasia
Intra-ventricular bleed
35 year old man came with sudden loss of consciousness
Arterio-venous malformation
CT Angiogram performed
Axial
Coronal
Sagittal
Haemorrhagic Neoplasm
Malignancy induced coagulopathy –Leukemia
Intra-tumoral bleed : Primary
: Metastatic
Intratumoral bleed
Common tumors are:
-Pituitary adenoma
-GBM
-Oligodendroglioma
-Ependymoma
-PNET
-Mets : Lung, renal, choriocarcinoma,
melanoma
Bleed in GBM
45 yrs old lady operated for Ca breast ,presented with right sided weakness
Iatrogenic Intracerebral bleed
Patient with MI – Post thrombolytic therapy, sudden loss of consciousness
Bleed in right BG