Neuro clinics - 16

Dr Pratyush Chaudhuri

Sponsored by Mankind Pharmaceuticals

www.arnicainheadinjury.hpage.com

NEURO CT IN ICU

Dr Pratyush Chaudhuri

Supported by Nirmal Clinics

Why CT ??

Less scan time as compared to MRI

Easy availability

Patients on life supporting equipment

which is a contraindication for MR

Post-operative debilitated patients

Physics Prof Hounsfield (British)

First CT machine made by Hitachi (Japan)

Hounsfield units (HU) - ranges from

- 1000 to +1000

CT Sectional Anatomy

Normal cerebral vascular anatomy

Common etiological classification

I. Intracranial haemorrhage

(traumatic & non-traumatic)

II. Infarct

III. Infective

IV. Congenital

I A. Traumatic intracranial haemorrhage

A. Subdural haemorrhage

B. Extradural haemmorhage

C. Subarachnoid haemorrhage

D. Haemorrhagic contusions

A. Subdural haemorrhage

Between dura and arachnoid

Crosses suturesCrescentic shapeAcute SDH-

hyperdenseChronic SDH-

hypodense

B. Extradural haemorrhage

Commonly associated

with fracture

Biconvex shape

Displace grey-white

matter interphase

Does not cross sutures

Extradural haemorrhage

Trauma with EDH & pneumocephalus

C. Subarachnoid haemorrhage

a. Traumatic SAH

b. Non-traumatic SAH seen in aneurysm rupture & hemorrhagic venous infarct

c. High density fluid collection in superficial sulci & cisterns

D. Traumatic haemorrhagic contusion

Foci of punctate or linear haemorrhage Common at grey-white matter junction

D.Traumatic haemorrhagic contusion

Cerebral edema

Multiple fractures

I b. Non-traumatic intracranial haemorrhage

i) Hypertensive haemorrhage

ii) Haemorrhagic infarction

iii) Aneurysm & vascular malformation

iv) Haemorrhagic neoplasm

v) Iatrogenic

i) Hypertensive haemorrhage

Common locations are:

• Putamen / external capsule• Thalamus• Pons • Cerebellum• Subcortical white matter

Hypertensive haemorrhage

Hypertensive encephalopathy

Pre-eclampsia / eclampsia (Common site is bilateral occipital region)

Chronic renal failureThrombotic thromocytopenic purpuraHemolytic uremic syndromeSLE

ii) Haemorrhagic Infarction

Arterial Infarction

Venous Infarction

Arterial Haemorrhagic Infarct

Common Cause of Haemorrhagic transformation is- Embolism

Post contrastPlain

Venous Infarct

Commonly associated with venous sinus thrombosis

Hyperdense sinus - Plain CT Empty delta sign- Contrast enhanced CT

Venous Thrombosis OR ??

50 year old lady with severe headache referred for CTA

iii) Aneurysms

Commonest presenting symptom is SAH

Intra-ventricular breakthrough

CT angiogram is helpful to demonstrate site of aneurysm

CT Angiogram

Post clipping bleed

iv) Vascular Malformation

Arterio venous Malformation

Cavernous angioma

Venous angioma

Capillary telangectasia

Intra-ventricular bleed

35 year old man came with sudden loss of consciousness

Arterio-venous malformation

CT Angiogram performed

Axial

Coronal

Sagittal

Haemorrhagic Neoplasm

Malignancy induced coagulopathy –Leukemia

Intra-tumoral bleed : Primary

: Metastatic

Intratumoral bleed

Common tumors are:

-Pituitary adenoma

-GBM

-Oligodendroglioma

-Ependymoma

-PNET

-Mets : Lung, renal, choriocarcinoma,

melanoma

Bleed in GBM

45 yrs old lady operated for Ca breast ,presented with right sided weakness

Iatrogenic Intracerebral bleed

Patient with MI – Post thrombolytic therapy, sudden loss of consciousness

Bleed in right BG