imaging of head trauma dr. thanh binh nguyen university of ottawa, canada july 2009
TRANSCRIPT
![Page 1: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/1.jpg)
IMAGING OF HEAD TRAUMA
Dr. Thanh Binh Nguyen
University of Ottawa, Canada
July 2009
![Page 2: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/2.jpg)
OUTLINE
Clinical indications for imaging Imaging technique Extraaxial hemorrhage Intraaxial injury Brain herniations Skull fractures
![Page 3: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/3.jpg)
INTRODUCTION
Head trauma is the leading cause of death in people under the age of 30.
Males have 2-3 x frequency of brain injury than females
Due mainly to motor vehicle accidents and assaults
![Page 4: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/4.jpg)
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
![Page 5: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/5.jpg)
![Page 6: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/6.jpg)
IMAGING TECHNIQUE
The presence of a skull fracture increases the risk of having a posttraumatic intracranial lesion.
However, the absence of a skull fracture does not exclude a brain injury, which is particularly true in pediatric patients due to the capacity of the skull to bend.
NO ROLE FOR PLAIN FILMS IN ACUTE HEAD TRAUMA
![Page 7: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/7.jpg)
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)
![Page 8: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/8.jpg)
OUR CT PROTOCOLS
“ROUTINE”: posterior fossa and supratentorial region (slice thickness = 5mm)
“TRAUMA”: posterior fossa (2.5mm), supratentorial region (5mm)
“TEMPORAL BONE”: <1mm in axial or coronal plane
“ORBITS/FACIAL BONES”: 1.25 mm axial/coronal orbits
![Page 9: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/9.jpg)
APPROACH TO CT BRAIN
Look at the scout film: ? Fracture of upper cervical spine or skull
Look for brain asymmetry Look at sulci, Sylvian fissure and cisterns to
exclude subarachnoid hemorrhage Change windows to look for subdural collection Look at bone windows to see fractures Determine if mass is intraaxial (in the brain) or
extraaxial (outside)
![Page 10: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/10.jpg)
![Page 11: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/11.jpg)
![Page 12: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/12.jpg)
![Page 13: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/13.jpg)
![Page 14: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/14.jpg)
![Page 15: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/15.jpg)
![Page 16: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/16.jpg)
![Page 17: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/17.jpg)
SCALP INJURY
![Page 18: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/18.jpg)
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.
![Page 19: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/19.jpg)
Extraaxial fluid collections
Subarachnoid hemorrhage(SAH) Subdural hematoma(SDH) Epidural hematoma Subdural hygroma Intraventricular hemorrhage
![Page 20: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/20.jpg)
![Page 21: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/21.jpg)
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
![Page 22: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/22.jpg)
![Page 23: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/23.jpg)
![Page 24: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/24.jpg)
![Page 25: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/25.jpg)
![Page 26: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/26.jpg)
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)
![Page 27: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/27.jpg)
![Page 28: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/28.jpg)
W=33 L=41
![Page 29: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/29.jpg)
![Page 30: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/30.jpg)
![Page 31: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/31.jpg)
![Page 32: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/32.jpg)
MANAGEMENT OF aSDH
Acute SDH with thickness > 10 mm or midline shift > 5mm should be evacuated
Patient in coma with a decrease in GCS by >2 points with a SDH should undergo surgical evacuation.
![Page 33: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/33.jpg)
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)
![Page 34: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/34.jpg)
![Page 35: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/35.jpg)
![Page 36: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/36.jpg)
MANAGEMENT OF aEDH
EDH > 30 cm3 should be evacuated.
EDH < 30 cm3 and <15 mm thickness and < 5 mm midline shift and GCS >8 may be managed nonoperatively with serial CT
![Page 37: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/37.jpg)
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
![Page 38: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/38.jpg)
![Page 39: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/39.jpg)
![Page 40: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/40.jpg)
![Page 41: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/41.jpg)
INTRA-AXIAL INJURY
Surface contusion/laceration Intraparenchymal hematoma White matter shearing injury/diffuse
axonal injury Post-traumatic infarction Brainstem injury
![Page 42: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/42.jpg)
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
![Page 43: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/43.jpg)
From http://neuropathology.neoucom.edu/Dr.Agamanolis
![Page 44: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/44.jpg)
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
![Page 45: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/45.jpg)
DIFFUSE AXONAL INJURY
Rarely detected on CT ( 20% of DAI lesions are hemorrhagic)
MRI: T1, T2, T2 GRE, SWI
![Page 46: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/46.jpg)
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
![Page 47: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/47.jpg)
DAI
Hours: hemorrhages and tissue tears Axonal swellings Axonal bulbs
Days/weeks: clusters of microglia and macrophages, astrocytosis
Months/years: Wallerian degeneration
![Page 48: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/48.jpg)
From http://neuropathology.neoucom.edu/Dr.Agamanolis
![Page 49: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/49.jpg)
![Page 50: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/50.jpg)
Sagittal T1-W images
![Page 51: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/51.jpg)
![Page 52: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/52.jpg)
Axial FLAIR images
![Page 53: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/53.jpg)
AXIAL FLAIR
![Page 54: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/54.jpg)
AXIAL T2 GRADIENT-ECHO
![Page 55: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/55.jpg)
![Page 56: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/56.jpg)
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
![Page 57: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/57.jpg)
18 biker hit by a car
![Page 58: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/58.jpg)
![Page 59: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/59.jpg)
![Page 60: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/60.jpg)
![Page 61: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/61.jpg)
![Page 62: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/62.jpg)
BRAIN HERNIATIONS
![Page 63: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/63.jpg)
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
![Page 64: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/64.jpg)
![Page 65: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/65.jpg)
![Page 66: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/66.jpg)
![Page 67: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/67.jpg)
![Page 68: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/68.jpg)
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
![Page 69: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/69.jpg)
![Page 70: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/70.jpg)
![Page 71: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/71.jpg)
![Page 72: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/72.jpg)
DOWNWARD HERNIATION Caudal displacement of the thalamus
and midbrain Effacement of the perimensencephalic
cistern and 4th ventricle. Can cause a 3rd nerve palsy and disrupt
pontine vessels leading to brainstem hemorrhage
![Page 73: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/73.jpg)
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
![Page 74: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/74.jpg)
TONSILLAR HERNIATION
Inferior displacement of the cerebellar tonsils through the foramen magnum
Can lead to posterior cerebellar artery infarction
![Page 75: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/75.jpg)
EXTERNAL HERNIATION
Due to a defect in the skull in combination with elevated ICP
Venous obstruction can occur at the margins of the defect.
![Page 76: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/76.jpg)
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)
![Page 77: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/77.jpg)
![Page 78: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/78.jpg)
![Page 79: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/79.jpg)
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
![Page 80: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/80.jpg)
![Page 81: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/81.jpg)
POST TRAUMATIC SEQUELAE Carotid-cavernous fistula(CCF) Dissection/pseudoaneurysm Infarction Atrophy/encephalomalacia Infection Leptomeningeal cyst
![Page 82: IMAGING OF HEAD TRAUMA Dr. Thanh Binh Nguyen University of Ottawa, Canada July 2009](https://reader036.vdocuments.us/reader036/viewer/2022062404/551b375a55034607418b66eb/html5/thumbnails/82.jpg)