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Systematic Approach to Reading a Non-Contrast Head CT Scan

Systematic Approach to Reading a Non-Contrast Head CT Scan. Systematic Approach. Assess each component of the intracranial cavity Blood Brain Bone CSF. Blood. Epidural Hematoma (EDH) Arterial Bleed: High-Pressure “Lens” Shape Middle Meningeal Laceration (Skull Fracture)

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Systematic Approach to Reading a Non-Contrast Head CT Scan

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  1. Systematic Approach to Reading a Non-Contrast Head CT Scan

  2. Systematic Approach Assess each component of the intracranial cavity • Blood • Brain • Bone • CSF

  3. Blood • Epidural Hematoma (EDH) Arterial Bleed: High-Pressure “Lens” Shape Middle Meningeal Laceration (Skull Fracture) • Subdural Hematoma (SDH) Venous Bleed: Low-Pressure “Crescent” Shape Acute / Chronic (Is Patient Anticoagulated? Alcoholic?) • Subarachnoid Hemorrhage (SAH) Traumatic / Aneurysmal • Intraventricular Hemorrhage (IVH) • Intraparenchymal Hemorrhage (IPH) Hypertensive Basal Ganglia or Lobar Cerebral Contusion “Coup-Contrecoup”

  4. EDH

  5. SDH: Acute/Chronic

  6. SAH (Aneurysmal)

  7. IVH

  8. IPH

  9. IPH

  10. Contusion Coup (Red) Contrecoup Contusion (Orange) (at 180 degrees)

  11. Brain • Symmetry (of Hemispheres) Hyper-/Hypodensities (Masses, Edema, Stroke) • Grey/White Matter Border Lost Grey-White Differentiation in Anoxic Injury • Midline Shift • Gyri/Sulci Wide Sulci: Atrophy Effaced Sulci: Edematous “Tight/Swollen” Brain • Pneumocephalus (Air in Brain) Open Fracture (or Craniotomy) Fracture through Sinus

  12. Mass

  13. Midline Shift

  14. Sulci/Gyri: Atrophy/Edema

  15. Bone • Fractures Especially Temporal Bones • Sinuses & Air Cells Look for Air-Fluid Levels

  16. Pneumocephalus

  17. Temporal Bone Fracture

  18. CSF: Ventricles & Cisterns • Ventricles Blood in Ventricles? Effacement/Asymmetry: Compression from Mass/Hematoma Hydrocephalus Atrophy (“Ex Vacuo”) Communicating / Obstructive Hydrocephalus If Obstructive, Where? Look at Lateral, 3rd, and 4th Ventricles • Cisterns Look for Effacement (Edema/Early Herniation) Look for Blood

  19. Cisterns/Effacement

  20. Ventricles/Hydrocephalus

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