HEAD CT SCAN IMAGING

by Nurhayani Dwi Susanti

Radiology Department - Zainoel Abidin Hospital
Banda Aceh - NAD

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

DONT BE FOOLED :
Normal Variant : calcification in the basal ganglia usually symmetric)

SUBARACHNOID HEMORRHAGE

Berry aneurysm

Trauma

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

SUBDURAL HEMATOMA

A collection of blood below the

inner layer of the dura but
external to the brain and
arachnoid membrane

EPIDURAL HEMATOMA

Underlying fracture

A tearing of the middle

meningeal artery

Biconvex in shape

Displacing the brain away from

skull

ACUTE SUBDURAL HEMATOMA

INTRAVENTRICULAR HEMORRHAGE

Trauma
Hypertension
Aneurysm

QUIZ

THIS HEAD CT SCAN SHOWS.

WHAT IS THE TYPE OF HEMORRHAGE IN THIS

PATIENT ?

WHAT IS THE TYPE OF HEMORRHAGE ?

a.

Subdural hematoma

b.

Epidural hematoma

c.

Subarachnoid hemorrhage

d.

Subgaleal hematoma

THIS HEAD CT SCAN SHOWS.

THIS PATIENT HAD .

a. Acute subdural hematoma
b. Acute epidural hematoma
c. Chronic subdural hematoma
d. Chronic subgaleal hematoma

THIS HEAD CT SCAN SHOWS.

THIS HEAD CT SCAN SHOWS.

THANK YOU

DIFFERENTIATING CYTOTOXIC FROM

VASOGENIC EDEMA

Cytotoxic
Grey and white matter
Wedge shape
Infarct

Vasogenic
Almost exclusively in white
matter tracts
Finger-like projections
Infection, XRT, tumor

DIFFUSE CEREBRAL EDEMA

Poor differentiation of gray from

white matter

No sulci visible