head trauma imaging of intracranial bleeds

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1、SrishtiGuptaGillianLieberman,MDNovember2000HeadTraumaHeadTraumaImagingofIntracranialBleedsImagingofIntracranialBleedsSrishtiGupta,HarvardMedicalSchool–YearIIIGillianLieberman,MDSrishtiGuptaNovember2000GillianLieberman,MDOurPatientOurPatient•85y/owomanfellathome,hittingRtempleoncornerof

2、table•ambulatedthenbecameunresponsive•IntheED...–Patientlethargic–Noexternalsignsofinjury–pupilsizeR3.5L2.5responsivetolight–BP208/palpableHR1122SrishtiGuptaNovember2000GillianLieberman,MDMenuoftestsforimagingheadtraumaMenuoftestsforimagingheadtrauma1.HeadCT2.HeadMRINoncontrastHeadCTis

3、thetestofchoiceas:•Thepatientisaccessibleifemergencyresuscitationisneeded•IVcontrastisnotneeded•Fast•Greatforidentifyingfracturesandbonefragments•Greatforidentifyingacutebleeds;theyappearhyperdense•Greatforevaluatingedemaandshift/herniation3SrishtiGuptaNovember2000GillianLieberman,MDIn

4、ordertorecognizetheabnormal,youfirstneedtoknowtheappearanceofthenormal.Onnon-contrastheadCT:BoneiswhiteWhiteCalciumiswhite;AcutehemorrhageisusuallywhiteBrainparenchymaislightgrey;LightGreyWhitematterisdarkerthangreymatterCSFisverydarkgrey;CharcoalGreySulci,cisternsandventriclesAirisbla

5、ck;BlackNasalcavity,sinuses,mastoidaircells4SrishtiGuptaNovember2000GillianLieberman,MDNormalAnatomyNormalAnatomy•Cacaudate•WMwhitematter•GMgreymatter•SPseptumpellucidumWM•CPchoroidplexus•LVlateralventriclesGMCPLV•Memedulla•FVfourthventricle•CBcerebellumFC•FCfalxcerebriBIDMC5SrishtiGup

6、taNovember2000GillianLieberman,MDNormalAnatomyNormalAnatomy•Cacaudate•WMwhitematter•GMgreymatterSP•SPseptumpellucidumCa•CPchoroidplexusTV•LVlateralventricles•TVThirdVentricle•MemedullaCi•FVfourthventricle•CBcerebellum•FCfalxcerebri•CiCisterns6BIDMCSrishtiGuptaNovember2000GillianLieberm

7、an,MDNormalAnatomyNormalAnatomy•Cacaudate•WMwhitematter•GMgreymatter•SPseptumpellucidum•CPchoroidplexus•LVlateralventriclesMe•ThirdVentricle•MemedullaCBFV•FVfourthventricle•CBcerebellum•FCfalxcerebri7BIDMCSrishtiGuptaNovember2000GillianLieberman,MDNormalAnatomyNormalAnatomy•SuturesFS