IMAGING IN

NEUROEMERGENCY
dr. Rohadi Sp.BS
FK Unram / RSUD Prov. NTB
Mataram-NTB
 
 Imaging Modality
Plainskull X ray
CT Scan
MRI
Angiography
 Plain Skull X ray
Provides little information
For evaluation of facial injury-----
nowadays we use MDCT
The presence of skull fracture places the
patient at a higher risk of intracranial
hemorrhage (Not always)
Skull Fracture
 CT Scan
 Readily available in the emergency setting.
 Rapid and non invasive
 Good delineation of skull fractures, paranasal sinuses
and soft tissue changes
 Accurate localization of foreign metalic bodies and
bony fragments
 Easy identification of intraaxial, extraaxial
hemorrhage, pneumocephalus and brain herniation
 Possibility of CTA of the neck and intracranial
vessels
 Easy evaluation of concomitant injuries in other body
regions
 Cara Baca CT Scan
 Dimulai dari :
1. Identitas pasien
 Pasien laki-laki/perempuan
 umur
 potongan axial/sagital/coronal

2. Dimulai dari bagian luar

 Didapatkan Scalp Hematom di Regio Fronto-Parietal Kanan
 Harus dimulai dengan menyebutkan bagian kanan dulu, baru
kemudian bagian kiri.
Batas- batas regio pada CT
Scan Kepala :
Venous Drainase
 MRI
 Accurate detection of traumatic vascular lesions
 Adequate identification of DAI
 Easy identification of all herniations
 Accurate prediction of patient’s outcome with
functional studies
 Less available in the acute setting because of its
length of examination and high costs
 Poor delineation of bony fractures.
 Contraindicated for patients with suspected metalic
foreign bodies (metalic bullets in gun shot trauma,
aneurysmal clips, pace maker)
 Extra-axial
EpiduralHematoma
Subdural Hematoma
Subarachnoid hemorrhage
Subdural Hygroma
R

R
R R
R R
Mixed SDH & EDH
Coup-Contre coup Injury
 Intra-axial
Hemorrhagic Cortical Contusion
Diffuse Axonal Injury (DAI)
Subcortical hemorrhage
Brainstem Injury
 Hemorrhagic Cortical Contusion

R
 Diffuse Axonal Injury (DAI)

• Hemorrhagic DAI lesions on SWI 6 times > T2*-weighted

2D GRE
• Imaging volume of hemorrhage approximately twofold
greater
Tong KA et al. Diffuse axonal injury in children: clinical correlation with hemorrhagic
lesions. Ann Neurol 2004;56:36–50
Diffuse Axonal Injury (DAI)
R R
SUBCORTICAL INJURIES

 SCI Petechial hemorrhages brainstem

(BS), BG, thalamus
 IVH hemorrhage within ventricular
system
Subcortical Injury
SUBCORTICAL INJURIES:
Brainstem
 Secondary Processes
Cerebral edema
Increased intracranial pressure
Herniation syndromes
Cerebral infarction
Pneumocephalus
 A. Subfalcine
(cingulate) herniation
 B. Uncal herniation
 C. Transtentorial
herniation
 D. External herniation
 E. Tonsilar herniation
 Skull Base Fracture
CSF Leak
o Infection
o Pneumocephalus
CNS Injury
o Deficit: Acute or delayed
Vascular Trauma
o Laceration or dissection
o Occlusion & infarction
o Fistulae (Carotico-Cavernous Fistulae)
R R
CCF
Vertebral Artery Dissection/Occlusion Secondary
to C6 Fracture