Blood Can Be Very Bad

8/11/2019 Blood Can Be Very Bad

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The Head CT.Phil Singer, EM1


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History of the CT1970- Sir Jeffrey Hounsfeld combined amathematical reconstruction formula with arotating apparatus that could produce and

detect x-rays... this became the modern day CTscanner.. He was knighted for thisaccomplishment.


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Why talk about head CTs.1. Most of us have to overlook a head CT.2. We use night hawks.3. Many studies have shown that there arehuge deficiencies in the ability to accuratelyread a head CT.


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Purpose of this discussion.To explain and demonstrate a methodicalapproach to reading head CTs for acuteintracranial emergencies and non-emergencies.

- Test your learning by active question andanswer.


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Pertinent AnatomyPosterior Fossa


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Pertinent AnatomyLow Cerebellum


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Pertinent AnatomyHigh Pons


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Pertinent AnatomyCerebral Peduncle


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Pertinent AnatomyBasal Ganglia


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Pertinent AnatomyHigh Midbrain


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Pertinent AnatomyLateral Ventricles.


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Pertinent AnatomyUpper Cortex


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Blood Can Be Very Bad.Methodical approach to reading head CTsdeveloped by Andrew Perron, MD, FACEP.


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Blood.BloodAcute hemorrhage appears hyperdense (brightwhite) on CT.Acute blood 50 to 100 HU


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CanCisternsCerebrospinal fluid collections jacketing thebrain; the following four key cisterns must be examinedfor blood, asymmetry, and effacement (representingincreased intracranial pressure):

- Circummesencephalic- Suprasellar- Quadrageminal- Sylvian


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CanCSF Flow:Lateral ventricles (Choroid plexus) >IIIrd Ventricle >Aqueduct of Sylvius > IVth Ventricle > Magendie andLushka > Subarachnoid space. 0.5-1cc/minute in adults. Adult CSF Volume = 150ccAdult CSF Production 500-700 cc/day (i.e. CSF turns 3-5 times/day)


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CisternsSuprasellar (star-shaped)Location of the circle of Wifrequent site of aneurysmal subarachnoidhemorrhage


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CisternsCircummesencephalicCerebrospinal fluid ring arounthe midbrain; first to be effaced with increasedintracranial pressure


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CisternsSylvian-Between temporal and frontal lobes; site oftraumatic and distal mid-cerebral aneurysm andsubarachnoid hemorrhage


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CisternsQuadrigeminalW-shaped cistern at top of midbrain;effaced early by rostrocaudal herniation


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BeBrain--Symmetry-Gray-White Differentiat ion-Shift-Hyper/Hypodensity
http://images.radiopaedia.org/images/1000/27c88bec9b8ef395f60b33a8ad3a30.jpghttp://images.radiopaedia.org/images/1000/27c88bec9b8ef395f60b33a8ad3a30.jpg


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VeryVentricles-hydrocephalus-compression/shift
http://neurosurgery.ufl.edu/files/2012/04/hydrocephalus-CT-scan.jpg


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BadBone--Symmetry-Blood inmastoids
http://img.medscape.com/pi/emed/ckb/radiology/336139-336140-343764-344042tn.jpg


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Subdural Hematoma


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Epidural Hematoma


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Orbital Blowout FX


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Pontine Hemorrhage


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Subarachnoid


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Toxoplasmosis


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Toxoplasmosis


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References

Blood Can Be Very Bad http://www.uic.edu/com/ferne/pdf/acep_2005_peds/perron_ich_acep_2005_peds_course.pdf

Computed Tomography (CT) Angiography (Angiogram)http://www.radiologyinfo.org/en/info.cfm?pg=a
http://www.radiologyinfo.org/en/info.cfm?pg=angiocthttp://www.radiologyinfo.org/en/info.cfm?pg=angiocthttp://www.uic.edu/com/ferne/pdf/acep_2005_peds/perron_ich_acep_2005_peds_course.pdfhttp://www.uic.edu/com/ferne/pdf/acep_2005_peds/perron_ich_acep_2005_peds_course.pdfhttp://www.uic.edu/com/ferne/pdf/acep_2005_peds/perron_ich_acep_2005_peds_course.pdf

Blood Can Be Very Bad

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