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Description : Check out this medical presentation on Radiology and Imaging, which is titled "Brain Imaging in Trauma", to know about Brain Imaging in Trauma.

Tags : Radiology, Imaging, Brain Imaging, Trauma

Published on : Aug 02, 2021 | Views : 2007 | Downloads : 12

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Brain Imaging in Trauma
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Level Of Consciousness Glasgow Coma Scale Eye Opening Best Verbal Best Motor Spontaneous 4 Oriented 5 To Voice 3 To Pain 2 None 1 Confused 4 Inappropriate 3 Incomprehensible 2 None 1 Obeys Command 6 Localizes 5 Withdraws 4 Flexion 3 Extension 2 None 1
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Primary Brain Injury
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Classification of TBI Primary Injury to scalp, skull fracture Surface contusion/laceration Intracranial hematoma Diffuse axonal injury, diffuse vascular injury Secondary Hypoxia-ischemia, swelling/edema, raised intracranial pressure Meningitis/abscess
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IMAGING TECHNIQUE CT without contrast is the modality of choice in acute trauma (fast, available, sensitive to acute subarachnoid hemorrhage and skull fractures) MRI is useful in non-acute head trauma (higher sensitivity than CT for cortical contusions, diffuse axonal injury, posterior fossa abnormalities)
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Extraaxial fluid collections Subarachnoid hemorrhage(SAH) Subdural hematoma(SDH) Epidural hematoma Subdural hygroma Intraventricular hemorrhage
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EPIDURAL HEMATOMA Located between the skull and periosteum Due to laceration of the middle meningeal artery or dural veins Can cross dural reflections but is limited by suture lines Lentiform shape (but concave shape in SDH)
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SUBDURAL HEMATOMA Occurs between the dura and arachnoid Can cross the sutures but not the dural reflections Due to disruption of the bridging cortical veins Hypodense(hyperacute, chronic), isodense(subacute), hyperdense(acute)
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Subarachnoid hemorrage Can originate from direct vessel injury, contused cortex or intraventricular hemorrhage. Look in the interpeduncular cistern and Sylvian fissure Usually focal (but diffuse from aneurysm) Can lead to communicating hydrocephalus
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Intraventricular hemorrhage Most commonly due to rupture of subependymal vessels Can occur from reflux of SAH or contiguous extension of an intracerebral hemorrhage Look for blood-cerebrospinal fluid level in occipital horns
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INTRA-AXIAL INJURY Surface contusion/laceration Intraparenchymal hematoma White matter shearing injury/diffuse axonal injury Post-traumatic infarction Brainstem injury
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CONTUSION/LACERATIONS Most common source of traumatic SAH Contusion: must involve the superficial gray matter Laceration: contusion + tear of pia-arachnoid Affects the crests of gyri Hemorrhage present ½ cases and occur at right angles to the cortical surface Located near the irregular bony contours: poles of frontal lobes, temporal lobes, inferior cerebellar hemispheres
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Intraparenchymal hematoma Focal collections of blood that most commonly arise from shear-strain injury to intraparenchymal vessels. Usually located in the frontotemporal white matter or basal ganglia Hematoma within normal brain DDx: DAI, hemorrhagic contusion
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DIFFUSE AXONAL INJURY Rarely detected on CT ( 20% of DAI lesions are hemorrhagic) MRI:T1,T2,T2 GRE, SWI
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DAI Due to acceleration/deceleration to whtie matter + hypoxia Patients have severe LOC at impact Grade 1: axonal damage in WM only -67% Grade 2:WM + corpus callosum (posterior > anterior) – 21% Grade 3:WM + CC + brainstem
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DAI Hours: hemorrhages and tissue tears Axonal swellings Axonal bulbs Days/weeks: clusters of microglia and macrophages, astrocytosis Months/years:Wallerian degeneration
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Axial FLAIR images
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AXIAL FLAIR
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T2 * & SWI
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BRAINSTEM INJURY By direct or indirect forces Most commonly associated with DAI Involves the dorsolateral midbrain and upper pons and is usually hemorrhagic Duret hemorrhage is an example of indirect damage: tearing of the pontine perforators leading to hemorrhage in the setting transtentorial herniation <20% of brainstem lesions are seen on CT
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SUBFALCIAL HERNIATION Subfalcial: displacement of the cingulate gyrus under the free edge of the falx along with the pericallosal arteries. Can lead to anterior cerebral artery infarction
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UNCAL HERNIATION Displacement of the medial temporal lobe through the tentorial notch Displacement of the midbrain Effacement of the suprasellar cistern Displacement of the contralateral cerebral peduncle against the tentorium Widening of the ipsilateral cerebello pontine angle Compression of the posterior cerebral artery
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Duret
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Kernohan - false ipsilateral
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UPWARD HERNIATION Due to posterior fossa mass causing superior displacement of the vermis through the tentorial incisura Compression of the 4th ventricle and effacement of the quadrigeminal plate cistern. Compression of the superior cerebellar artery & pca
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TONSILLAR HERNIATION Inferior displacement of the cerebellar tonsils through the foramen magnum Can lead to posterior cerebellar artery infarction
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Skull Fractures Thin skull #’s common place. Risk of # associated intracranial injuries? CT to R/o Open Closed Comminuted Diastatic Depressed
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SIGNIFICANT SKULL FRACTURES “Depressed”: inner table is depressed by the thickness of the skull. Overlie major venous sinus, motor cortex, middle meningeal artery Pass through sinuses Look for sutural diastasis (lambdoid)
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TEMPORAL BONE FRACTURES Look for opacification of the mastoid Longitudinal: 70%, parallel to long axis of petrous bone, conductive hearing loss (from ossicular dislocation), facial nerve paralysis (20%) Transverse: 20%, sensorineural hearing loss, facial nerve paralysis (50%) Complex Complications: meningitis, abscess
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SCALP INJURY
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SCALP INJURY Cephalohematoma: blood between the bone and periosteum. Cannot cross the suture lines. Subgaleal hematoma: blood between the periosteum and aponeurosis. Can cross the suture lines. Caput Succ: swelling across the midline with scalp moulding. Resolves spontaneously.
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POST TRAUMATIC SEQUELAE Carotid-cavernous fistula(CCF) Dissection/pseudoaneurysm Infarction Atrophy/encephalomalacia Infection Leptomeningeal cyst
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