27. Imaging in neurotrauma.

From greek.doctor
  • Modalities
    • Non-contrast CT head
      • Trauma
      • Suspected intracranial haemorrhage
        • For example “worst headache of my life”
      • (Not in tension headache)
    • MRI head
      • Pre-operative work up
  • Haemorrhage on non-contrast CT
    • Acute – hyperdense
    • Subacute – isodense with brain
    • Late/chronic – hypodense
  • Epidural haematoma
    • Arterial origin
      • Mostly middle meningeal arterty
    • Findings
      • Biconvex hyperdense lesion
      • Sharply demarcated
      • Doesn’t displacement meninges
      • Is limited by suture lines
      • Can cross falx and tentorium
      • Has mass effect
  • Subdural haemoatoma
    • Venous origin
      • Mostly bridging veins
    • Findings
      • Crescent shaped hyperdense lesion
      • Falx cerebri displaced
        • Bleeding can be parafalcine
      • Is between dura and arachnoid
      • Not limited by suture lines (can cross them)
      • Has mass effect (can cause midlift shift due to displacement)
    • The intensity of the lesion changes with time from hyperdense to isodense to hypodense
    • Clinical features
      • “Worst headache of my life”/thunderclap headache
      • Altered mental status
      • Photophobia
      • Nuchal rigidity
      • Vomiting