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1、EricSwartMS3GillianLieberman,MDJanuary2007IntracranialHemorrhageandSequelaeEricSwart,HarvardMedicalSchoolYearIIIGillianLieberman,MDEricSwartMS3GillianLieberman,MDAgenda•PatientPresentation•Briefreviewofneuroanatomy•Causesofhemorrhageandradiologicappearance•Imagingprinciplesofbl
2、ood•Physiologyandconsequencesofhemorrhage2EricSwartMS3GillianLieberman,MDPatient1•83y/oMwithIDDM,CAD,andCRIpresentss/pfallinhomewithRUextremityredness.•Furtherhistoryrevealsmultipleminorfallsoverpastmonthassociatedwithdizzinessandminorheadtrauma.•CurrentmedicationsincludeASA•An
3、yimaging?3EricSwartMS3GillianLieberman,MDOurPatient:AdmissionCTAxialCTofhead,initiallyreadas“normal”Lesiononfalx?4CourtesyofDr.HandwerkerEricSwartMS3GillianLieberman,MDOurPatient:HeadCTHospitalDay3Ptfoundunresponsiveina.m.5CourtesyofDr.HandwerkerEricSwartMS3GillianLieberman,MDO
4、urPatient:SubduralHematomaMidlineshiftLayeringHemorrhagePossibleSubarachnoidCompressionofventricles6CourtesyofDr.HandwerkerEricSwartMS3GillianLieberman,MDAnatomyReviewEpiduralSubduralIntraparenchymal7http://www.surgery.ucsf.eduEricSwartMS3GillianLieberman,MDCompanionPt1:Epidura
5、lHematomaonCT•Usuallyduetotrauma(deceleration)•Brieflucidinterval•Lacerationofthemeningealarteries(althoughcanbevenous!)•“Lentiform”•Doesnotcrosssutureshttp://www.muhealth.org/~neuromed/8EricSwartMS3GillianLieberman,MDCompanionPt2:EpiduralHematomaonCTHematoma9CourtesyofDr.Handw
6、erkerEricSwartMS3GillianLieberman,MDCompanionPt2:CranialFractureonCTFracture10CourtesyofDr.HandwerkerEricSwartMS3GillianLieberman,MDCompanionPt4:SubduralHematomaonCT•Usuallyduetotrauma(shearing)•Gradualonsetofsx•Tearsinthesmallbridgingveins•Crescent-shaped•Cancrosssutures,butno
7、tmidlinehttp://www.sbhemresidency.com/11EricSwartMS3GillianLieberman,MDCompanionPt5:SubduralHematoma?Hypodenselesion,possiblechronicbleed?12CourtesyofDr.HandwerkerEricSwartMS3GillianLieberman,MDCompanionPt5:SubduralHematoma?AxialDiffusionWeightedMRIHyperintenselesioninsubdurals
8、pace13CourtesyofDr.HandwerkerEricSwartMS3GillianLieber
