by Nurhayani Dwi Susanti

Radiology Department - Zainoel Abidin Hospital

Banda Aceh - NAD

HEAD CT SCAN IMAGING

NORMAL 40 YEARS OLD

HEMORRHAGE

• INTRACRANIAL HEMORRHAGE – POSSIBLE LOCATION

Intraparenchymal

Intraventricular

Subarachnoid

Subdural / epidural

• INTRAPARENCHYMAL BLEEDING

location, location, location…

Hypertensive bleed – most common (80%)

Basal ganglia

Thalamus

Pons

Cerebellum

INTRAPARENCHYMAL BLEEDING

• Atypical locations like cerebral hemispheres

AVM

Aneurysm

Berry and mycotic

Trauma

Amyloid angiopathy

Tumor

Vascular mets, primary tumor

Vasculitis, coccaine, amphetamine, bleeding diathesis, anticoagulation, etc

Intraparenchymal bleed

CT – natural history

Accompanied by vasogenic edema, some mass effect

• Consider enhanced scan for mass effect out of proportion to size of hematoma

• Possibility of underlying tumor

Much later, thin slit of hypodensity is seen at site of bleed

DON’T BE FOOLED :

Normal Variant : calcification in the basal ganglia usually symmetric)

• Berry aneurysm

• Trauma

SUBARACHNOID HEMORRHAGE

SUBDURAL & EPIDURAL HEMATOMA

• Usually traumatic in origin

• Subdural

Venous bleed

Low pressure

Slow growth

• Epidural

Arterial bleed

High pressure

Rapid growth

• Both may be life-threatening from mass effect and herniation

• A collection of blood below the inner layer of the dura but external to the brain and arachnoid membrane

SUBDURAL HEMATOMA

• Underlying fracture

• A tearing of the middle meningeal artery

• Biconvex in shape

• Displacing the brain away from skull

EPIDURAL HEMATOMA

ACUTE SUBDURAL HEMATOMA

• Trauma

• Hypertension

• Aneurysm

INTRAVENTRICULAR HEMORRHAGE

QUIZ

THIS HEAD CT SCAN SHOWS….

WHAT IS THE TYPE OF HEMORRHAGE IN THIS PATIENT ?

a. Subdural hematoma

b. Epidural hematoma

c. Subarachnoid hemorrhage

d. Subgaleal hematoma

WHAT IS THE TYPE OF HEMORRHAGE ?

THIS HEAD CT SCAN SHOWS….

a. Acute subdural hematoma

b. Acute epidural hematoma

c. Chronic subdural hematoma

d. Chronic subgaleal hematoma

THIS PATIENT HAD ….

THIS HEAD CT SCAN SHOWS….

THIS HEAD CT SCAN SHOWS….

THANK YOU

• Cytotoxic

Grey and white matter

Wedge shape

Infarct

• Vasogenic

Almost exclusively in white matter tracts

Finger-like projections

Infection, XRT, tumor

DIFFERENTIATING CYTOTOXIC FROM VASOGENIC EDEMA

• Poor differentiation of gray from white matter

• No sulci visible

DIFFUSE CEREBRAL EDEMA