1. Reading a Head CT (Trauma) Daniel Weingrow D.O.

2. Overview Who shouldn’t get a Head CT? Who should get a Head CT? How a CT is born Anatomy Blood Can Be Very Bad 5 S’s Extra-Axial Hematoma Easy to Miss Lesions Cases

3. Main Point Blood Can Be Very Bad B C B V B

4. Main Point Blood Can Be Very Bad Blood C B V B

5. Main Point Blood Can Be Very Bad Blood Cisterns B V B

6. Main Point Blood Can Be Very Bad Blood Cisterns Brain V B

7. Main Point Blood Can Be Very Bad Blood Cisterns Brain Ventricles B

8. Main Point Blood Can Be Very Bad Blood Cisterns Brain Ventricles Bone and Soft Tissue

9. No CT?... If you don’t have a neurosurgeon

10. No CT? Radiation / Malignant Cancer – (VOMIT) Cognitive decline Cost $300-600 Sedation Time in ER

12. Risk of Cancer 1:1000

14. Who to CT? Adults NOC NEXUS II Canadian Head CT Rule Pediatrics Kupperman

19. How a CT scan is made

20. Not true sagittal cuts – parallel to base of skull

21. Mathematically constructed digital image(Not a direct radiographic image)

22. Radiographic Densities = Hounsfield Units

23. CT can discriminate tissue density to a greater detail than can be displayed on single gray scale Brain Blood Bone Window Window Window

24. Volume Averaging Artifact

25. Motion Artifact

26. Beam hardening (low frequency absorbed) -> Streak Artifact

27. Neuroanatomy!

28. Orientation Orbits Petrous portion of temporal bone Sylvian fissure

29. The Coffee Bean

30. The Worms

31. Mr. Sad

32. Mr. Happy

33. The Heart

34. The Star

35. The X

36. Blood Can Be Very Bad

37. HU of Blood, Fluid properties of blood

38. Blood Intraaxial Cortical Contusion Brain stem/ Deep Injury DAI IVH SAH - sulci Extraaxial SDH – crosses suture EDH – crosses falx and tent

39. Cortical Contusion

40. Hemorrhage + edema of gyri from bone impact

42. DAI

43. Extra-Axial Hematomas

45. Normal CT scan

46. How old?

47. 5S’s of Extra Axial - Hematoma Size – #slices (each slice 0.5cm thick), measure Signs and Symptoms Shifts and Serious Consequences (of ICP) Side – view from patients toes Site

48. Blood Can Be Very Bad Cisterns

49. Flow of CSF

50. Flow of CSF Quadrigeminal plate c Superior Cellabellarc Cisterna Magna Perimesencephalicc Interpeduncularc Prepontinec Supracellarc

51. Mr. Happy

52. The Heart

53. The Star

54. The X

55. Blood Can Be Very Bad Brain

56. Brain GW interface Intraaxial and extra-axial lesions Gyri tight?

57. Blood Can Be Very Bad Ventricles – less ventricles = more problems

58. Ventricles Midline Shift Septum Pellicidum Juan Valdez Sign Cerebral Aqueduct Hydrocephalus Ex vacou Communicating Non-communicating Respect the Fourth

59. Midline Shift

60. Juan Valdez Sign

61. Hydrocephalus

62. Please Communicate!

63. Big Ventricles but… Hydrocephalus ex vacuo

64. Respect the Fourth

65. The Star

66. Respect the Fourth

67. Blood Can Be Very Bad Bone and Soft Tissue

68. Bone and Soft Tissue Identify Coup, Contra-coup Basilar Skull Fracture Pneumocephalus – base or open fx Sphenoid Sinus, Ethmoid Sinus, Mastoid Air Cells Facial Trauma

69. Coup - Scalp

70. You won’t see this

71. Clinical Signs – Basilar Skull Fracture 1 2 3 4

72. Pneumocephalus Can also be caused by open skull fx

73. Check the sinuses/ Facial Trauma

74. Overview Who shouldn’t get a Head CT? Who should get a Head CT? How a CT is born Anatomy Blood Can Be Very Bad 5 S’s Extra-Axial Hematoma Easy to Miss Lesions Cases