Académique Documents
Professionnel Documents
Culture Documents
•Blood
•Cisterns
•Brain
•Ventricles
•Bone 5
Blood Can Be Very Bad
•Blood
•Cisterns
•Brain
•Ventricles
•Bone 6
Blood Can Be Very Bad
•Blood
•Cisterns
•Brain
•Ventricles
•Bone 7
Blood Can Be Very Bad
•Blood
•Cisterns
•Brain
•Ventricles
•Bone 8
Blood Can Be Very Bad
•Blood
•Cisterns
•Brain
•Ventricles
•Bone 9
CT Scan Basics
• A CT image is a computer-generated picture
based on multiple x-ray exposures taken
around the periphery of the subject.
• X-rays are passed through the subject, and a
scanning device measures the transmitted
radiation.
• The denser the object, the more the beam is
attenuated, and hence fewer x-rays make it to
the sensor.
10
CT Scan Basics
• The denser the object, the whiter it is on CT
• Bone is most dense = + 1000 Hounsfield U.
• Air is the least dense = - 1000H Hounsfield U.
11
CT Scan Basics: Windowing
15
CT Scan
2 Key Level Sagittal View
nd 2 nd Key Level
Circummesencephalic Cistern
17
Cisterns at Cerebral Peduncles Level
18
CT Scan
19
CT Scan
20
3 Key Level Sagittal View
rd
Circummesencephalic Cistern
21
Cisterns at High Mid-Brain Level
22
CT Scan
CSF Production
• Produced in choroid plexus in the lateral
ventricles Foramen of Monroe IIIrd
Ventricle Acqueduct of Sylvius IVth
Ventricle Lushka/Magendie
• 0.5-1 cc/min
• Adult CSF volume is approx. 150 cc’s.
• Adult CSF production is approx. 500-700 cc’s
per day. 24
1 day 1 year 2 years
26
B is for Blood
• Acute blood is bright white
on CT (once it clots).
30
Subdural Hematoma
• Typically falx or sickle-shaped.
• Crosses sutures, but does not
cross midline.
• Acute subdural is a marker for
severe head injury. (Mortality
approaches 80%)
• Chronic subdural usually slow
venous bleed and well
tolerated.
31
Subarachnoid Hemorrhage
32
Subarachnoid Hemorrhage
• Blood in the cisterns/cortical gyral surface
• Aneurysms responsible for 75-80% of SAH
• AVM’s responsible for 4-5%
• Vasculitis accounts for small proportion (<1%)
• No cause is found in 10-15%
• 20% will have associated acute hydrocephalus
33
CT Scan
34
CT Scan
35
Intraventricular/
Intraparenchymal Hemorrhage
CT Scan
37
C is for CISTERNS
(Blood Can Be Very Bad)
• 4 key cisterns
• Circummesencephalic
• Suprasellar
• Quadrigeminal
• Sylvian
Circummesencephalic
38
Cisterns
• 2 Key questions to answer regarding cisterns:
• Is there blood?
• Are the cisterns open?
39
40
41 Andrew D. Perron, MD, FACEP
B is for BRAIN
(Blood Can Be Very Bad)
42
43
Tumor
44
Atrophy
45
Abscess
46
Hemorrhagic Contusion
47
Mass Effect
48
Intracranial Air
49
Intracranial Air
50
51
52
53
54
55 Andrew D. Perron, MD, FACEP
Blood Can Be Very Bad
If no blood is seen, all cisterns
are present and open, the brain
is symmetric with normal gray-
white differentiation, the
ventricles are symmetric without
dilation, and there is no fracture,
then there is no emergent
diagnosis from the CT scan. 56
Text Book
• David Sutton’s Radiology
• Clark’s Radiographic positioning and techniques
Assignment
• Two students will be selected for assignment.
Question
• Define differences between subdural and epidural hematoma?
• Thank You