2013 CT head

Recognition of abnormal Head
CT findings

2013 Sue Crowley

2013 Sue Crowley

Until the CT tech took images to show what the problem was
2013 Sue Crowley

Content
•
•
•
•
•
•
•
•
•

Head Trauma
Facial Trauma
Intracranial hemorrhage
Intercranial pressure
Stroke
Ruptured aneurysms
Hydrocephalus
Brain tumours
Multiple sclerosis
2013 Sue Crowley

The Canadian CT Head Rule head rule • will permit physicians to standardize care of patients with head injuries and to be much more selective in the use of computed tomography without jeopardizing patient care. • http://www.ohri.ca/emerg/cdr/docs/c
2013 Sue Crowley dr_cthead_poster.pdf Nonpathalogic calcifications
•
•
•
•

Pineal gland
Basal ganglia
Choroid plexus
Falx and tentorium

2013 Sue Crowley

Normal structures that enhance
•
•
•
•

Venous sinuses
Choroid plexus
Pituitary gland and stalk
Metal densities – streak artifacts

2013 Sue Crowley

Normal CT scans of Head

2013 Sue Crowley

Normal CT scans of Head

2013 Sue Crowley

Systematic approach
• Check patient information
• Review scan protocol (C or no C)
• Check scout image (obvious fractures, gross abnormality, alignment of upper C spine vertebra)
• First quick pass – followed by more detailed analysis
• Use ABBCS to remember NB structures
• Extend search to orbits, sinuses, oropharynx, ears, craniocervical junction, face vault and scalp

2013 Sue Crowley

ABBC’S
• A - Asymmetry
• B - Blood
• B - Brain
• Abnormal density
• Displacement
• Grey and white matter differentiation

• C - CSF spaces
• Cisterns, sulci & ventricles

• S - skull & scalp
2013 Sue Crowley

ABBCS - Asymmetry
• assess all slices comparing one side to the other
• remember to allow for head tilt and various types of artifacts

http://en.wikipedia.org/wiki/File:Asymmetric_(PSF).png

2013 Sue Crowley

ABBCS - Blood
• Acute hemorrhage
– Hyperdense in relation to brain
• Due to clot reaction and water loss

– Typical CT numbers
• 50 – 100HU

• What to Assess
– Blood overlying the cerebral