Head Trauma - Head CT
Head Trauma - Head CT
Search Pattern Assist ?Exam
Purpose
1. Recognize direct impact type of injuries resulting in hematomas in defined extraaxial spaces. These occur most commonly with fractures crossing the course of the meningeal arteries (i.e. anterior/middle/posterior meningeal arteries, and the occipital meningeal arteries).
2. Recognize direct impact type of injuries resulting in intraaxial brain contusions or contusions caused by impact with the free margins of dura or calvarium.
3. Recognize direct impact type of penetrating injuries resulting in very focal hematomas corresponding to the course of the offending agent (i.e. bullet, knife, screw driver, nail gun, etc.).
4. Recognize indirect impact (acceleration-deceleration) injuries producing linear macro or microhemorrhages and linear white matter fasicles injuries, especially in the major forceps of the corpus callosum.
5. Recognize indirect impact - (acceleration-deceleration) shear injuries producing tissue injury and macro or micro hemorrhages along the gray-white matter junction
6. Recognize indirect impact (acceleration-deceleration) arterial shear injuries involving only tethered (pial input but deep venous egress) arteries, which includes mainly the centronuclear perforators, penetrating arteries into the corpus callosum, and mesencephalic perforators. These vascular shear injuries produce multiple microhemorrhages & punctate tissue injuries.
7. Recognize venous tether injuries involving mainly superficial (pial) cortical veins tethered by their insertion into the dural sinuses. Less commonly, the central thalamostriate veins can be involved (tethered to the ICV-vein of Galen-apex straight sinus). The hallmark of venous tether injuries is hemorrhage along the course of the vein and possibly brain laceration (linear tissue injury associated with the course of the egress veins to the involved vein).
8. Recognize the effects of superimposed HIE events (asphyxiation, cardiac trauma, cauda brain stem stretch injuries) onto the concurrent traumatic injuries.
9. Recognize the effects of proximal arterial injuries causing stroke events to be superimposed on to the traumatic injuries.
10. Recognize the effects of distal arterial stroke events on to the traumatic injuries, because of pial artery compressions along free dural margins (i.e. falx, tentorium) or entrapment in fractures.
11. Recognize the effects of dural venous occlusion superimposed on the traumatic injuries, because of dural venous compression by fractures or epidural hematomas.
12. Assess for intraxxial hemorrhagic brain contusions or superficial "gliding" contusions over rough bone surfaces (i.e. orbit roof, top of temporal bone, sphenoid ridge).
13. Assess for subependymal or intraventricular hemorrhages.
14. Assess for punctate intraaxial macro or microhemorrhages in the white matter (especially the major forceps-corpus callosum) or in the gray-white matter junction to indicate white matter shear effects of the acceleration-deceleration injury mechanism.
15. Assess for intraaxial macro or microhemorrhages in the centronuclear structures or corpus callosum to indicate arterial microvascular shear effects of the acceleration-deceleration injury mechanism.
16. Assess for linear hematomas following the course of pial veins to suggest venous tether vascular shear injuries related to acceleration-deceleration injury mechanism.
Purpose for post contrast CT/CTA or MR/MRA
1. Assess for any focal or regional change in the venocapillary pool volume sufficient to explain mass effect without hemorrhagic contusion.
2. Assess for extradural or proximal intradural arterial injury (i.e. para-arterial fluid, dissection, pseudoaneurysm, occlusion, AV fistula).
3. Assess for dural sinus or cortical vein high grade (post compressive) stenosis or occlusion.
4. Assess for any entrapped pial artery in a skull fracture.
Findings
Head CT
There is evidence of subperiosteal hemorrhage along either the inner or outer calvarial surface. [Yes/No]
There is evidence of epidural hemorrhage (acute-meningeal artery bleed vs delayed-diploic venous bleed). [Yes/No]
There is evidence of intradural hemorrhage (usually Peds patients). [Yes/No]
There is evidence of subdural hemorrhage. [Yes/No]
There is evidence of hemorrhage into CSF spaces including subarachnoid, intraventricular, or subpial spaces. [Yes/No]
There is evidence epidural/sub periosteal/parenchymal blood outside dural sinuses, especially for injury adjacent to the superior sagittal or transverse sinuses. [Yes/No]
There is evidence of epidural blood adjacent to fx near meningeal arteries. [Yes/No]
Mixed-age CNS injuries in the absence of clear history in a child is very suspicious for NAI. [Yes/No]
Assess for intracranial/intraaxial or intraventricular post traumatic injuries
There is evidence of intraaxial direct impact injuries: brain contusion or superficial gliding contusions (over orbital roof or petrous bone). [Yes/No]
There is evidence of intraaxial/extraaxial direct impact injuries (coup event) and opposite side (contre coup event), which can include intraventricular hemorrhage. [Yes/No]
There is evidence of brain laceration from missile type penetrating injuries. [Yes/No]
There is evidence of intraaxial (non-direct impact acceleration-deceleration) brain shear injuries or diffuse axonal injuries (i.e. DAI) causing microhemorrhages at the gray-white junction or along the major forceps of the corpus callosum. [Yes/No]
There is evidence of microhemorrhage from arterial microvascular shear effect (from acceleration-deceleration vector) in corpus callosum. [Yes/No]
There is evidence of microhemorrhage from arterial microvascular shear effect (from acceleration-deceleration vector) in the BG/thalamus, or brainstem. [Yes/No]
There is evidence of venous tether avulsion injuries, possibly with brain laceration (linear parenchymal hemorrhage). [Yes/No]
Assess for focal, regional, or diffuse brain swelling
There is evidence of any focal intracranial post traumatic mass (or hydrocephalus) producing brain herniation. [Yes/No]
There is evidence of regional brain swelling from dysautoregulation and expanded intravascular pool, but without apparent brain edema. [Yes/No]
There is evidence of intercurrent PCA or circummesencephalic artery stroke(s) from tentorial herniation. [Yes/No]
There is evidence of intercurrent ACA stroke from subfalcine shift. [Yes/No]
There is evidence of intercurrent ICA stroke from traumatic injury or from uncal brain herniation compressing across the interclinoidal ligament. Can also be caused by choking compressing ICA in neck in NAI. [Yes/No]
There is evidence of an extraaxial hemorrhage adjacent to, and displacing or occluding a dural sinus. [Yes/No]
There is evidence of focal posterior temporal intra or extraaxial mass effect (usually associated with temporal bone fracture) compressing or occluding the V of Labbe’ and/or transverse sinus. [Yes/No]
There is evidence of global (diffuse) cytogenic edema likely related to concurrent apneic episode with cytotoxic brain edema. [Yes/No]
Assess for arterial or venous injury on CTA (or MRA)
There is evidence of major proximal or pial arterial post traumatic dissection. [Yes/No]
There is evidence of pial or meningeal arterial entrapment in a fracture. [Yes/No]
There is evidence of major arterial post traumatic injury producing a pseudoaneurysm. [Yes/No]
There is evidence of major arterial post traumatic injury producing a high or low flow AV fistula. [Yes/No]
There is evidence of deformity (external compression) or thrombosis of a dural sinus. [Yes/No]
There is abnormal capillary leak in areas of lost blood brain barrier, abnormal venocapillary pool density, or actual abnormal contrast enhancement if a focal lesion. [Yes/No]
Other
There is evidence of concurrent abnormalities not likely related to recent brain injury. [Yes/No]
