Blood Can Be Very Bad

8/11/2019 Blood Can Be Very Bad

1/37

The Head CT.Phil Singer, EM1


2/37

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.


3/37

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.


4/37

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.


5/37

Pertinent AnatomyPosterior Fossa


6/37

Pertinent AnatomyLow Cerebellum


7/37

Pertinent AnatomyHigh Pons


8/37

Pertinent AnatomyCerebral Peduncle


9/37

Pertinent AnatomyBasal Ganglia


10/37

Pertinent AnatomyHigh Midbrain


11/37

Pertinent AnatomyLateral Ventricles.


12/37

Pertinent AnatomyUpper Cortex


13/37

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


14/37

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


15/37

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

- Circummesencephalic- Suprasellar- Quadrageminal- Sylvian


16/37

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)


17/37

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


18/37

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


19/37

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


20/37

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


21/37

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


22/37

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


23/37

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


24/37


25/37

Subdural Hematoma


26/37


27/37

Epidural Hematoma


28/37


29/37

Orbital Blowout FX


30/37


31/37

Pontine Hemorrhage


32/37


33/37

Subarachnoid


34/37


35/37

Toxoplasmosis


36/37

Toxoplasmosis


37/37

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

Documents

Transcript of Blood Can Be Very Bad