CT SCAN OF

HEAD TRAUMA
PRESENTANT: JUWITA VALEN
RAMADHANIA, S.KED
I4061171009
CONSULENT: DR. INDRIA FAJRIANITA
SP.RAD
 BASIC
• Brain is the reference density
• Higher = whiter appearance =
hyperdense
• Lower = darker appearance =
hypodense
• Same density = isodense
 GENERAL CONSIDERATION
• Nonpathologic calcifications
• Pineal gland
• Choroid plexus
• Falx and tentorium
• Basal ganglia
• After administration of iodinated
intravenous contrast, several normal
structures can enhance:
• Venous sinuses
• Choroid plexus
• Pituitary gland and stalk
NORMAL CT SCAN
INDICATION FOR CT & MRI
STUDIES
 HEAD TRAUMA
• The primary goal is to identify is a life-
threatening but treatable lesion.
• In order to visualize skull fractures, you must
view the CT scan using the "bone windows".
• The most common orbital fracture is the "blow-
out" fracture, which is produced by direct
impact on the orbit (baseball in the eye),
which produces a sudden increase in
intraorbital pressure causing a fracture of the
inferior orbital floor (into the maxillary sinus)
or the medial wall of the orbit (into the
ethmoid sinus).
 HEAD TRAUMA
• Recognizing a blow-out fracture of the orbit
• Orbital emphysema—air in the orbit from
communication with one of the adjacent air-
containing sinuses, either the ethmoid or
maxillary sinus
• Fracture through either the medial wall or floor of
the orbit
• Entrapment of fat or extraocular muscle that
project downward as a soft tissue mass into the
maxillary sinus
• Fluid (blood) in the maxillary sinus.
• A tripod fracture is a common facial fracture
that involves separation of the
frontozygomatic suture, fracture of the floor
of the orbit, and fracture of the lateral wall of
 SKULL FRACTURE

Linear fracture Depressed

fracture
 SKULL FRACTURE

Blow out
fracture
 HEMORRHAGE
• There are three types of extra-axial,
intracranial hemorrhages:
• Epidural hematoma
• Subdural hematoma
• Subarachnoid hemorrhage
 EPIDURAL HEMATOMA
• Epidural hematomas represent hemorrhage into the
potential space between the dura mater and the
inner table of the skull.
• Most cases are due to injury to the middle meningeal
artery or vein from blunt head trauma, classically a
motor vehicle accident.
• Almost all epidural hematomas (95%) have an
associated skull fracture.
• Recognizing an epidural hematoma
• High-density, extra-axial, biconvex lens-shaped
mass lesion most often found in the
temporoparietal region of the brain.
• Does not cross sutures (subdurals do)
• Can cross tentorium (subdurals don't)
THE MENINGES
EPIDURAL HEMATOMA
 SUBDURAL HEMATOMA
• More common than epidural hematomas
• Most commonly a result of deceleration
injuries in motor vehicle or motorcycle
accidents (younger patients) or falls (older
patients).
• They represent hemorrhage into the
potential space between the dura mater
and the arachnoid.
• Subdural hematomas are usually produced
by damage to the bridging veins that cross
from cerebral cortex to the venous sinuses
of the brain.
 SUBDURAL HEMATOMA
Recognizing an acute subdural hematoma
• Crescent-shaped, extracerebral band of high
attenuation that may cross suture lines and
enter the interhemispheric fissure.
• They do not cross the midline.
• Typically SDH is concave inward to the brain
(epidural hematomas are convex inward).
• As time passes and they become subacute, or if
the subdural blood is mixed with lower
attenuating CSF, they may appear isointense
(isodense) to the remainder of brain, in which
case you should look for sulci displaced away
from the inner table.
 SUBDURAL HEMATOMA
• Chronic subdural hematoma
• More than 3 weeks after injury
• Chronic subdural hematomas are usually
low density
 SUBDURAL HEMATOMA

A. There is a crescent-shaped, extracerebral band of high-density blood

(closed white arrow) concave inward toward the brain. Herniation of the
brain is indicated by the dilated contralateral temporal horn (open white
arrow). B. As they become subacute, subdural hematomas become less
dense and may be the same density as the normal brain tissue. You can
recognize an isodense subdural hematoma by the unilateral effacement or
displacement of the sulci away from the inner table of the skull (dotted
white arrow) compared to the normal opposite side. C. Chronic
subduralhematomas are more than 3 weeks old and usually are of low
 INTRACEREBRAL
occurringHEMATOMA
• Injuries at the point of impact (coup) and
injuries occurring opposite the point of impact
(contrecoup) are most common following trauma.
• Coup injuries are most often due to shearing of small
intracerebral vessels.
• Contrecoup injuries are acceleration/deceleration injuries
that occur when the brain is propelled in the opposite
direction and strikes the inner surface of the skull.
• Either of these mechanisms can produce a cerebral
contusion.
• Contusions are hemorrhages with associated edema
usually found in the inferior frontal lobes and temporal
lobes on or near the surface of the brain.
 INTRACEREBRAL
HEMATOMA
Recognizing traumatic intracerebral hemorrhage
on CT
• Multiple, small, well-demarcated areas of high
attenuation within the brain parenchyma on CT.
• Surrounded by a rim of hypoattenuation from
edema
• Mass effect is common.
• Compression of the ventricles, shift of the third
ventricle and septum pellucidum to the
opposite side
• At risk for subtentorial and subfalcine brain
herniation and death
• Intraventricular blood may be present.
INTRACEREBRAL
HEMATOMA
 DIFFUSE AXONAL INJURY
• The injury responsible for prolonged coma
following head trauma and the injury with the
poorest prognosis.
• Acceleration/deceleration forces diffusely injure
axons deep to the cortex, producing
unconsciousness from the moment of injury.
• Most often the result of a motor vehicle
accident
• The corpus callosum is most commonly
affected and the initial CT scan may
underestimate the degree of injury.
• CT findings may be similar to those described
for intracerebral hemorrhage following head
trauma.
DIFFUSE AXONAL INJURY
 INCREASED INTRACRANIAL
PRESSURE
• Some of the clinical signs of increased
intracranial pressure:
• Papilledema
• Headache and diplopia
• In general, increased intracranial pressure is
due to either
• Increased volume of the brain (cerebral
edema) or
• Increased size of the ventricles
 CEREBRAL EDEMA
• In adults, trauma, hypertension (associated as it is
with intracerebral bleeds and stroke), and masses
are the most common causes of diffuse brain
edema.
• There are two types of cerebral edema: vasogenic
and cytotoxic.
• Vasogenic edema represents extracellular
accumulation of fluid and is the type that is
associated with malignancy and infection.
• It is due to abnormal permeability of the blood-
brain barrier.
• It predominantly affects the white matter.
• Cytotoxic edema represents cellular edema and is
associated with cerebral ischemia.
• It is due to cell death.
 CEREBRAL EDEMA
Recognizing cerebral edema
• Loss of normal differentiation between gray and
white matter
• Effacement (narrowing or obliteration) of the
normal sulci
• Ventricular compression
• Herniation of the brain, which is manifest, in
part, by effacement of the basilar cisterns
• Subfalcine herniation
• The lateral ventricle and septum pellucidum
herniate beneath the falx and shift across the
midline toward the opposite side.
• Transtentorial herniation
• The cerebral hemispheres are displaced downward
CEREBRAL EDEMA
 LITERATURE
• HERRING, WILLIAM. LEARNING RADIOLOGY:
RECOGNIZING THE BASIC. 1ST ED. 2007.
 THANK
THANK YOU!
YOU!
RADIOLOGY