Paleerat Jariyakanjana, MD

Faculty of Medicine, Naresuan University

25 Oct 2013

Head Injury & Head CT

แนวทางการรกษาการบาดเจ็�บท��ศี�รษะ2008

head injured patient

มี�ประวั�ติแน่�น่อน่วั�าศี�รษะถู�กกระทบ ติรวัจพบมี�บาดแผลท��หน่�งศี�รษะหร�อหน่�าผาก มี�การเปล��ยน่แปลงควัามีร� �สึ$กติ�วัแมี�เพ�ยงชั่��วัขณะ

Low risk Moderate risk High risk

AsymptomaticGCS 15No headache

VomitingLoss of consciousnessDiffuse headachePost-traumatic amnesiaVertigoLarge contusion / laceration / subgaleal hematomaAge <2 or ≥60 yrOn anticoagulant or antiplateletAlcohol intoxication with GCS 14Multiple traumaChild abuseSign of base skull fracture

Skull fractureGCS 13-14 without intoxicationNeurological deficitPenetrating skull injuryPost-traumatic seizure

Observe at home with instruction sheet

Consult neurosurgeon + CT scan

HEAD CT

Trauma

Trauma

Trauma

Trauma

Nontrauma

Acute stroke

Cytotoxic edema Loss of gray/white matter differentiation

• Insular ribbon sign• Disappearing basal ganglia sign

Effacement of cortical sulci Subtle low attenuation

Middle cerebral artery sign

Hypoattenuating brain tissue

Obscuration of the lentiform nucleus

Insular Ribbon sign

Dense MCA sign

Non-trauma

 Basal ganglia haemorrhage

Nontrauma

Nontrauma

ANY QUESTIONS?