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CT Brain:

CT Brain By/ Eman Samy Hamama House Officer at Tanta university hospitals

Introduction:

Introduction CT brain is X Ray imaging procedure that generates images of cranium and intracranial contents as aresult of specific X Ray absorbtion by tissues examined..

Indication of CT brain:

Indication of CT brain 1- Head trauma 2- Stroke 3-Headache 4-Evaluation of space ocupying lesions 5- Seizeures 6-Suspcted hydrocephalus 7-Suspected intracranial hematoma 8-tingling .numbness.muscle weakness .hearing loss.speech difficultes.vertigo.

Contraindications of CT brain :

Contraindications of CT brain No absolute contraindication . Relative contraindicated in pregnancy in first trimaster for fear of foetal abnormalites(Risk Benfit Ratio)

Precautions before CT :

Precautions before CT 1-if female prgenant or not 2-any metalic object must be stored away(image artifact) 3-if CT with contrast advise the patient not to eat nor drink for few hours 4-ask about renal disease/DM if receiving Metformin(Glucophage) 5- ask about allergy to dye 6- ask about previous exposure to radiation 7- Lactating female stop lactation for 24 hours after CT with contrast

How to read CT Brain?:

How to read CT Brain? CT Brain consists of 2windows 1-Bone window 2- Brain window

Bone Window:

Bone Window Search for 1- Extra galial heamatoma 2-fracture 3- Intracranial air

When to do CT after head trauma?:

When to do CT after head trauma? 1-Bleeding ear or nose 2-Otorehea 3-Rhinorehea 4-Disturbed consious 5-Extremes of age 6-attack of convulsion 7-history of eplipsy 8-Signs of increased ICT as(headache.blurring of vision.projectile vomiting)

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Note that any patient with trauma may complain of nausea and vomiting due to vagal stimmulation..

Intracranial Air:

Intracranial Air This indicates an open head injury ..it indicates need for atibiotics..No surigical interference except if compressing the brain ..

Extra glail heamatoma:

Extra glail heamatoma

Fracture Base Skull:

Fracture Base Skull These are not always visible .. This is important as such patients are prone to devolping meningitis and requiring antibiotics prophalaxis.. If there is Bleeding nose or ear \CSF Rhinorrhoea \ Otorhea … .No need to exclude by CT .

Where is the fracture?:

Where is the fracture? Frontal Fossa Fracture presented by 1- Sub conjunctival Hge. 2-Bleeding per nose. 3-Rhinorrhea(salty due to high content of cholaride..with sneezing and straining and leaning forwards due to increasd ICT..doesnot stiffen in ahandkerchief.) 4- Halo Sign

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Fracture middle fossa presented by 1- bleeding per ear 2-Otorhea

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Fracture posterior fossa presented by 1-Oedema at mastiod process(pitting oedema)

Battle sign:

Battle sign

Bleeding Ear :

Bleeding Ear

Halo Sign:

Halo Sign (Ring Sign) If there is CSF mixed with Blood.It will move by capillary Action further away from the Centre than the blood will.

Subconjunctival HGE:

Subconjunctival HGE Not that HE is traingular and base of traingle towards brain ..to differniate it from HE related to eye(base of traingle towards eye)

Racoon Eyes:

Racoon Eyes

Brain Window :

Brain Window Search for 1-Brain Oedema 2-Hematoma 3- Infarction 4-Space ocupying lesions

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Density in CT brain 1-hyperdense(white) as bone and blood . 2-Isodense as brain. 3-Hypodense as air and CSF.

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There are 2exceptions 1-the pineal body (calcified) in the middle of the CT scan of most adults. 2-the calcified choroid plexus which is located in the body of each lateral ventricle.

1- Extra dural hematoma:

1- Extra dural hematoma 1-Biconvex 2-White 3-Stop at suture line as dura is inserted in to sutures.. 4-May cause comprssion of ipsilatral ventricle and dilatation of the contralateral ventricle. 5-Arise between table of skull and dura matter. 6- They usually devolp from injury to the middle mningeal artery or one of its branches and therefore are usually tempropariatal in location.

2- Subdural hematoma:

2- Subdural hematoma 1-Arise between the dura and arachnoid 2-Often from ruptured veins crossing this potential space.the space enlarges as the brain atophies so it is common in eldery. 3-Crescentic appearance with irrgular inner margin. 4-Not limited by suture line.

Chronic sub dural hematoma :

Chronic sub dural hematoma 1- The aetiology is not always clear. 2-It is probably due to minor repeated trauma. 3-Syptoms are vague and often devolp slowly with gradual deterioration of consious. 4- Crescentic and hypodense. 5- Do MRI to differniate it from brain atrophy .

Subarachanoid Hge:

Subarachanoid Hge This may occur alone or in association with other intracerebral or extracerebral hematomas. 2- Increased attenuation is seen in the CSF spacs .over cerebral hemispheres.. 3- SAH may be complicated by hydrocphalus. 4- SAH may be traumatic or due to ruptured aneursm or AV malformation...taking history is very important.

Intracerebral Hge:

Intracerebral Hge This is due to stretching and shearing injury often due to impaction of the brain against the skull on the opposite side to the injury …

Brain Oedma :

Brain Oedma 1- It is acumalation of fluied in the brain tissue. 2- Caused by trauma or infection or tuomer .Becuse skull cannot expand to accomadate the fluid pressure.brain tissue is compressed. 3-It appears in the form of darkening and decreased grey white matter differentiation. 4-It may be diffuse or focal. 5- Early syptoms include change of level of consious and repeated vomiting. 6- Sometimes may be difficult to detect by CT and need MRI.

Ischemic Stroke:

Ischemic Stroke

Stroke:

Stroke When blood flow to brain stops for 7sconds so brain cannot get oxygen nor blood so cells dye and brain damaged (Brain attack). There are 2types Ischemic and Hamorrhagic stroke.

Hydrocphalus:

Hydrocphalus It is abnormal acummalation of CSF in ventricls of brain.It causes increased ICT ..It may be congenital or acquired..communicating or non communicating.

Brain tuomurs :

Brain tuomurs

Brain Atrophy:

Brain Atrophy

MS:

MS

Brain Absess:

Brain Absess

With great thanks to :

With great thanks to 1- DR/Ahmed ans zahra. 2- DR/ Raed Abdelmaboud. 3-DR/Ahmed fathi Saleh. 4- DR\Mohamed ELsherif.

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THANK YOU

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