1. CT scan in head and spine injuries
By : Dr Ahmed Mohammed Debes
سایت جامع رادیولوژی

2. Brief history

3. Basic physics Hounsfield Units
tissue’s attenuation coefficient the ability to “block” X-rays. relatively constant
mapped onto Hounsfield scale from –1000 (black) to (white).
the brain tissue is the point of reference.
Any tissue “whiter” than brain tissue is hyper dense
while any tissue “blacker” than brain tissue is hypo dense
Basic physics
Image acquisition

4. What to look for in CT scan brain of a head trauma patient ?
I - Skull Fracture
II – Pneumo-cephalus
III - Hematoma
IV - Cerebral Edema
V - Herniation
What to look for in CT scan brain of a head trauma patient ?

5. I - Skull Fracture I - Linear, non-depressed fracture
Look in head CT bone window
I - Linear, non-depressed fracture
I - Skull Fracture

6. II - Depressed fracture
Consider open when
- Skin laceration over the fracture
- Through par nasal sinuses, middle ear structures
Surgical elevation in
- Depressed > 5 mm and overlies motor or speech areas
- Depressed > skull thickness
Causes laceration of Dura, arachnoid and possible brain parenchyma

7. III - Diastatic fracture
Spreading of suture, 1-2 mm more than normal contralateral side
May tear Dural venous sinus

8. IV - Basilar fracture Presentations
- CSF otorrhea, bruising over mastoid (Battle sign)
- CSF rhinorrhea, bruising around the eyes (raccoon eyes)

9. II - Pneumocephalus Presence of air in the cranial cavity
Indicates communication between intracranial and extra cranial spaces
complications:
meningitis, CSF otorrhea or rhinorrhea
II - Pneumocephalus

10. III - Hematoma I - Epidural Hematoma Source of bleeding
most commonly middle meningeal artery
Don't cross sutures
Hyper dense biconvex extra-axial mass
III - Hematoma

11. II - Subdural Hematoma Source of bleeding torn cortical bridging veins
Can cross suture
Can extend into interhemispheric fissure
Hyper dense crescent blood collection

12. III - Traumatic Subarachnoid Hemorrhage
Source of bleeding
Tear of veins in subarachnoid space
High density blood in sulci/cisterns

13. IV - Cerebral Contusion
due to cerebral gyri impact inner table of the skull
Evolve from petechial hemorrhage -> small hemorrhage ->large hematoma
Multiple, bilateral
MRI is better for detection

14. III - Cerebral Edema Generally resolves within 2 weeks
- loss of grey/white matter interface
- compressed ventricles
- effacement of the sulci
III - Cerebral Edema

15. IV - Herniation I - Midline Shift & Subfalcine Herniation
Subfalcine herniation is herniation of Cingular gyrus underneath the falx cerebri.
Presence of midline shift usually
signify Subfalcine herniation, and vice
versa.
IV - Herniation

16. II - Transtentorial herniation
Central herniation is defined as both temporal lobes descend through the tentorial incisura
Effacement of the cistern around the midbrain

17. III - Tonsillar Herniation
- obliteration of CSF space
- displaced portions of cervicomedullary junction

18. I - Compression fracture
CT scan in spine trauma

19. II – Burst fracture

20. III – Flexion fracture

21. III – fracture dislocation

22. The end
Thank you