Brain CT Scans in Clinical Practice | SpringerLink
Published on Aug 11, Great presentation on CT imaging of brain. Must for physicians. SlideShare Explore Search You. Submit Search.
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Are you sure you want to Yes No. Show More. No Downloads. Views Total views. This is due to the fact that the globin molecule is relatively dense and hence effectively absorbs x-ray beams. Peidural hematoma Convex shape Subdural hematoma Cresent shape Intra parenchymal hemorrhage in putamen Sub arachnoid hemorrhage hyperdensities in sylvian fissure, basal cysterns Intraparenchymal haemorrhage with intraventricular extension Infact immediate CT scans may be completely normal in these cases.
This is aggravated by vascular injury and leakage of proteins in the interstitial space.
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By days, interstitial fluid accumulates in the infarct and around it. Infarcts Non-contrast CT scan of a year-old male with sudden onset right hemiplegia two and a half hours prior to the CT scan. He is diabetic and hypertensive. The CT findings are often only as important as the question it was intended to answer! What was the clinical question in requesting a CT scan Here?
Non-contrast CT scan of the same patient after 8 hours now showing the obvious left basal ganglia infarct Justifying the need of follow up scans. Lacunar infarct in Basal ganglia. Infarcts Anterior cerebral artery infarct Posterior cerebral artery infarct CT appearance of increased intracranial pressure: A: normal intracranial pressure B: elevated intracranial pressure. Increasing degrees of temporal horn Dilatation in worsening hydrocephalus Gross hydrocephalus, showing dilatation of frontal horns, body and occipital horns.
Effacement of sulci due to raised ICP Contrast-enhanced CT may show beginning meningeal enhancement, which becomes more accentuated in later stages of disease. Meningeal enhancement in case of meningitis Pre- and post-contrast CT scans of a year-old male that presented with seizures. Effect of contrast is obvious.
Lesions show smooth outline of the rings of enhancement. The most common locations are basal ganglia, thalamus, pons, and cerebellum. Hemorrhages outside these common locations may be secondary to tumors or vascular malformation. Caudate nuclei, putamen and globus pallidus are collectively known as basal ganglia. Internal capsule is a white matter structure located adjacent to deep nuclei. Figure 4: Axial brain CT scan a and corresponding schematic picture b represent the basal ganglia and associated structures.
Figure 5: Axial brain CT scan of a year-old woman that presented with left-sided paraparesis, shows a hyperdense hemorrhage in the right basal ganglia asterisk.
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Note the adjacent hypodense edema black arrow and mass effect on the lateral ventricle white arrow. The most common secondary parenchymal hemorrhages encountered in the emergency departments are traumatic. Traumatic hemorrhages may be intra-axial within brain parenchyma or extra-axial.
Intra-axial hemorrhages like contusions or hemorrhagic diffuse axonal injuries are discussed here. Extra-axial hemorrhaged will be discussed later. Contusions are caused by impaction of brain parenchyma on hard bony protrusions, so direct contact with bony protrusions affects cortical grey matter figure 6. They are most commonly seen in frontal and temporal lobes figure 7. They are often hemorrhagic and easily seen on computed tomography.
In the control CT scans after a few days, the perilesional edema progresses, and the lesions become more readily visible. Figure 6: Schematic representation of common locations for the contusion. Contusions most commonly occur in inferior portions of the frontal lobe, temporal lobe, underneath the direct impact coup or at the opposite site of direct impact countre-coup. Figure 7: Axial brain CT scan in a trauma patients shows multiple hemorrhagic lesions in the right frontal a and right temporal b lobes consistent with contusions.
Note the perilesional hypodense edema. In case of rotational acceleration traumas brain traumas associated with rotations and change of speed , white matter and grey matter experience slightly different changes of speed.
This disrupts axons at the grey-white interfaces figure 8. This kind of lesion is called diffuse axonal injury DAI.
Brain CT Scans in Clinical Practice
Figure 8: Schematic representation of diffuse axonal injury. Rotational forces disrupt the axons at grey-white junctions. MRI remains the most sensitive modality for detecting these lesions. When visible on CT, they present as hemorrhagic foci in the grey-white interface, near deep nuclei of the brain and in the corpus callosum figure 9. Multiple hyperdense hemorrhagic lesions are seen in the grey-white junction a , adjacent to thalamus b and corpus callosum c. Multiplicity and location of the lesions are compatible with diffuse axonal injury. In most cases, abnormal hypodensities represent cerebrovascular accidents involves the cortex or edema secondary to other pathologies usually without cortical involvement.
Stroke is defined as acute onset of focal neurologic defect due to cerebrovascular compromise. This finding —being the result of arterial thrombosis- is the earliest finding in the CT scan of acute ischemic stroke. If you are able to discern the sign and diagnose a stroke in this phase, be proud of yourself! There is cortical hypodensity in the left frontal lobe arrow that represents ischemic infarct in the territory of the anterior cerebral artery. Figure Axial non-contrast CT shows a faint hypodense area in the left frontoparietal area suggesting ischemic stroke.
Sulcus effacement is noted in comparison to the other side arrow. Note the subtlety of findings in the acute phase of stroke. Extra-axial spaces are defined as the space within the skull that is not part of brain parenchyma. Meningeal layers engulf the parenchyma and separate it from the calvarium.
The meninges are composed of three layers: pia mater that is in direct contact with grey matter and contains supplying capillaries , arachnoid network that contains CSF and absorbs it into dural veins via arachnoid granulations and dura mater that is in direct contact with periosteum. The layers are depicted schematically in figure Epidural space is a potential space located between the periosteum and dura mater.