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    How To Read A Head CT: (Or "How I Learned To Stop Worrying and Love Computed Tomography")

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    Crhistian David García Montoya
    The document introduces a mnemonic ("Blood Can Be Very Bad") to help emergency physicians systematically interpret head CT scans. It breaks down the mnemonic into its components: Blood, Cisterns, Brain, Ventricles, and Bone. For each component, it provides examples of normal findings and various pathologies that may appear on head CT scans. The goal is to introduce a structured method for interpreting CT scans similar to how physicians are taught to interpret ECGs.

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    How To Read A Head CT: (Or "How I Learned To Stop Worrying and Love Computed Tomography")

    Uploaded by

    Crhistian David García Montoya
    26 views89 pages
    The document introduces a mnemonic ("Blood Can Be Very Bad") to help emergency physicians systematically interpret head CT scans. It breaks down the mnemonic into its components: Blood, Cisterns, Brain, Ventricles, and Bone. For each component, it provides examples of normal findings and various pathologies that may appear on head CT scans. The goal is to introduce a structured method for interpreting CT scans similar to how physicians are taught to interpret ECGs.

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    The document introduces a mnemonic ("Blood Can Be Very Bad") to help emergency physicians systematically interpret head CT scans. It breaks down the mnemonic into its components: Blood, Cisterns, Brain, Ventricles, and Bone. For each component, it provides examples of normal findings and various pathologies that may appear on head CT scans. The goal is to introduce a structured method for interpreting CT scans similar to how physicians are taught to interpret ECGs.

    Copyright:

    © All Rights Reserved
    Download as PPS, PDF, TXT or read online from Scribd
    Download as pps, pdf, or txt
    26 views89 pages

    How To Read A Head CT: (Or "How I Learned To Stop Worrying and Love Computed Tomography")

    Uploaded by

    Crhistian David García Montoya
    The document introduces a mnemonic ("Blood Can Be Very Bad") to help emergency physicians systematically interpret head CT scans. It breaks down the mnemonic into its components: Blood, Cisterns, Brain, Ventricles, and Bone. For each component, it provides examples of normal findings and various pathologies that may appear on head CT scans. The goal is to introduce a structured method for interpreting CT scans similar to how physicians are taught to interpret ECGs.

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    How to Read a Head CT

    (or How I learned to stop


    worrying and love computed
    tomography)

    Andrew D. Perron, MD, FACEP


    EM Residency Program Director
    Department of Emergency Medicine
    Maine Medical Center
    Portland, ME
    Andrew D. Perron, MD, FACEP

    Head CT
    Has assumed a critical role in the daily
    practice of Emergency Medicine for
    evaluating intracranial emergencies.
    (e.g. Trauma, Stroke, SAH, ICH).
    Most practitioners have limited
    experience with interpretation.
    In many situations, the Emergency
    Physician must initially interpret and act
    on the CT without specialist assistance.
    Andrew D. Perron, MD, FACEP

    Head CT
    Most EM training programs have no
    formalized training process to meet this
    need.
    Many Emergency Physicians are
    uncomfortable interpreting CTs.
    Studies have shown that EPs have a
    significant miss rate on cranial
    CT interpretation.

    Andrew D. Perron, MD, FACEP

    Head CT
    In medical school, we are taught a
    systematic technique to interpret ECGs
    (rate, rhythm, axis, etc.) so that all
    aspects are reviewed, and no findings
    are missed.

    Andrew D. Perron, MD, FACEP

    Head CT
    The intent of this session is to introduce
    a similar systematic method of cranial
    CT interpretation, based on the
    mnemonic

    Andrew D. Perron, MD, FACEP

    Head CT

    Blood Can Be Very Bad


    Andrew D. Perron, MD, FACEP

    Blood Can Be Very Bad


    Blood
    Cisterns
    Brain
    Ventricles
    Bone
    Andrew D. Perron, MD, FACEP

    Blood Can Be Very Bad


    Blood
    Cisterns
    Brain
    Ventricles
    Bone
    Andrew D. Perron, MD, FACEP

    Blood Can Be Very Bad


    Blood
    Cisterns
    Brain
    Ventricles
    Bone
    Andrew D. Perron, MD, FACEP

    10

    Blood Can Be Very Bad


    Blood
    Cisterns
    Brain
    Ventricles
    Bone
    Andrew D. Perron, MD, FACEP

    11

    Blood Can Be Very Bad


    Blood
    Cisterns
    Brain
    Ventricles
    Bone
    Andrew D. Perron, MD, FACEP

    12

    CT Scan Basics
    Introduced in 1974 by Sir Jeffrey Hounsfield.
    The original Siretom Circa 1974

    Andrew D. Perron, MD, FACEP

    13

    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 xrays make it to the sensor.
    Andrew D. Perron, MD, FACEP

    14

    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.

    Andrew D. Perron, MD, FACEP

    15

    CT Scan Basics: Windowing

    Focuses the spectrum of gray-scale used on a particular image.


    16

    Andrew D. Perron, MD, FACEP

    2 Sheet Head CT

    Posterior Fossa
    Brainstem
    Cerebellum
    Skull Base
    Clinoids
    Petrosal bone
    Sphenoid bone
    Sella turcica
    Sinuses

    Andrew D. Perron, MD, FACEP

    18

    CT Scan

    Andrew D. Perron, MD, FACEP

    19

    CT Scan

    Sagittal
    View

    Cisterns

    Andrew D. Perron, MD, FACEP

    22

    CT Scan

    Andrew D. Perron, MD, FACEP

    23

    Brainstem Lateral View

    Andrew D. Perron, MD, FACEP

    24

    nd

    Key

    nd
    2
    Key
    Level
    Level Sagittal

    View

    Andrew D. Perron, MD, FACEP

    25

    Cisterns at Cerebral
    Peduncles Level

    Andrew D. Perron, MD, FACEP

    26

    CT Scan

    Andrew D. Perron, MD, FACEP

    27

    Suprasellar Cistern

    Andrew D. Perron, MD, FACEP

    28

    CT Scan

    3 Key Level Sagittal View


    rd

    Andrew D. Perron, MD, FACEP

    30

    Cisterns at High Mid-Brain


    Level

    Andrew D. Perron, MD, FACEP

    31

    CT Scan

    Ventricles

    Andrew D. Perron, MD, FACEP

    33

    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 ccs.
    Adult CSF production is approx. 500700 ccs per day.
    Andrew D. Perron, MD, FACEP

    34

    CT Scans

    36

    Andrew D. Perron, MD, FACEP

    Trauma
    Pictures

    PATHOLOGY

    B is for Blood
    1st decision: Is blood present?
    2nd decision: If so, where is it?
    3rd decision: If so, what effect is it
    having?

    Andrew D. Perron, MD, FACEP

    39

    B is for Blood
    Acute blood is bright white
    on CT (once it clots).
    Blood becomes isodense
    at approximately 1 week.

    Blood becomes
    hypodense at
    approximately 2 weeks.

    B is for Blood
    Acute blood is bright white
    on CT (once it clots).
    Blood becomes isodense

    at approximately 1 week.

    Blood becomes
    hypodense at
    approximately 2 weeks.

    B is for Blood
    Acute blood is bright white
    on CT (once it clots).
    Blood becomes isodense

    at approximately 1 week.

    Blood becomes
    hypodense at
    approximately 2 weeks.

    Epidural Hematoma
    Lens shaped
    Does not cross sutures
    Classically described
    with injury to middle
    meningeal artery
    Low mortality if treated
    prior to
    unconsciousness
    ( < 20%)
    Andrew D. Perron, MD, FACEP

    43

    CT Scan

    CT Scans

    Andrew D. Perron, MD, FACEP

    45

    Subdural Hematoma
    Typically falx or sickleshaped.
    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.
    Andrew D. Perron, MD, FACEP

    46

    CT Scan

    47

    Andrew D. Perron, MD, FACEP

    CT Scan

    48

    Andrew D. Perron, MD, FACEP

    Subarachnoid Hemorrhage

    Andrew D. Perron, MD, FACEP

    49

    Subarachnoid Hemorrhage
    Blood in the cisterns/cortical gyral surface
    Aneurysms responsible for 75-80% of SAH
    AVMs responsible for 4-5%
    Vasculitis accounts for small proportion (<1%)
    No cause is found in 10-15%
    20% will have associated acute hydrocephalus

    Andrew D. Perron, MD, FACEP

    50

    CT Scan Sensitivity for SAH


    98-99% at 0-12 hours
    90-95% at 24 hours
    80% at 3 days
    50% at 1 week
    30% at 2 weeks
    Andrew D. Perron, MD, FACEP

    51

    CT Scan

    52

    Andrew D. Perron, MD, FACEP

    CT Scan

    53

    Andrew D. Perron, MD, FACEP

    Intraventricular/
    Intraparenchymal Hemorrhage

    54

    Andrew D. Perron, MD, FACEP

    CT Scan

    55

    Andrew D. Perron, MD, FACEP

    C is for CISTERNS
    (Blood Can Be Very Bad)
    4 key cisterns
    Circummesencephalic
    Suprasellar
    Quadrigeminal
    Sylvian

    Andrew D. Perron, MD, FACEP

    56

    Cisterns
    2 Key questions to answer regarding
    cisterns:
    Is there blood?
    Are the cisterns open?

    Andrew D. Perron, MD, FACEP

    57

    58

    Andrew D. Perron, MD, FACEP

    59

    Andrew D. Perron, MD, FACEP

    60

    Andrew D. Perron, MD, FACEP

    B is for BRAIN
    (Blood Can Be Very Bad)

    61

    Andrew D. Perron, MD, FACEP

    62

    Andrew D. Perron, MD, FACEP

    Tumor

    63

    Andrew D. Perron, MD, FACEP

    Atrophy

    64

    Andrew D. Perron, MD, FACEP

    Abscess

    65

    Andrew D. Perron, MD, FACEP

    Hemorrhagic Contusion

    66

    Andrew D. Perron, MD, FACEP

    Andrew D. Perron, MD, FACEP

    67

    68

    Andrew D. Perron, MD, FACEP

    Mass Effect

    69

    Andrew D. Perron, MD, FACEP

    Stroke

    70

    Andrew D. Perron, MD, FACEP

    71

    Andrew D. Perron, MD, FACEP

    72

    Andrew D. Perron, MD, FACEP

    Intracranial Air

    Andrew D. Perron, MD, FACEP

    73

    Intracranial Air

    74

    Andrew D. Perron, MD, FACEP

    Intracranial Air

    75

    Andrew D. Perron, MD, FACEP

    V is for VENTRICLES
    (Blood Can Be Very Bad)

    Andrew D. Perron, MD, FACEP

    76

    77

    Andrew D. Perron, MD, FACEP

    78

    Andrew D. Perron, MD, FACEP

    Ex-Vacuo Phenomenon

    79

    Andrew D. Perron, MD, FACEP

    80

    Andrew D. Perron, MD, FACEP

    81

    Andrew D. Perron, MD, FACEP

    BONE

    82

    Andrew D. Perron, MD, FACEP

    83

    Andrew D. Perron, MD, FACEP

    84

    Andrew D. Perron, MD, FACEP

    85

    Andrew D. Perron, MD, FACEP

    86

    Andrew D. Perron, MD, FACEP

    Three Stooges

    Blood Can Be Very Bad


    If no blood is seen, all cisterns
    are present and open, the brain
    is symmetric with normal graywhite differentiation, the
    ventricles are symmetric without
    dilation, and there is no fracture,
    then there is no emergent
    diagnosis from the CT scan.
    Andrew D. Perron, MD, FACEP

    88

    RIP

    Questions
    www.ferne.org
    [email protected]
    Andrew D. Perron, MD, FACEP
    [email protected]
    (207) 662-7015
    ferne_acep_2005_spring_perron_ich_bcbvb.ppt

    07/19/15 12:02

    Andrew D. Perron, MD, FACEP

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