Download - Neuro clinics 16 ct scan for icu settings
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Neuro clinics - 16
Dr Pratyush Chaudhuri
Sponsored by Mankind Pharmaceuticals
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NEURO CT IN ICU
Dr Pratyush Chaudhuri
Supported by Nirmal Clinics
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Why CT ??
Less scan time as compared to MRI
Easy availability
Patients on life supporting equipment
which is a contraindication for MR
Post-operative debilitated patients
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Physics Prof Hounsfield (British)
First CT machine made by Hitachi (Japan)
Hounsfield units (HU) - ranges from
- 1000 to +1000
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CT Sectional Anatomy
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Normal cerebral vascular anatomy
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Common etiological classification
I. Intracranial haemorrhage
(traumatic & non-traumatic)
II. Infarct
III. Infective
IV. Congenital
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I A. Traumatic intracranial haemorrhage
A. Subdural haemorrhage
B. Extradural haemmorhage
C. Subarachnoid haemorrhage
D. Haemorrhagic contusions
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A. Subdural haemorrhage
Between dura and arachnoid
Crosses suturesCrescentic shapeAcute SDH-
hyperdenseChronic SDH-
hypodense
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B. Extradural haemorrhage
Commonly associated
with fracture
Biconvex shape
Displace grey-white
matter interphase
Does not cross sutures
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Extradural haemorrhage
Trauma with EDH & pneumocephalus
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C. Subarachnoid haemorrhage
a. Traumatic SAH
b. Non-traumatic SAH seen in aneurysm rupture & hemorrhagic venous infarct
c. High density fluid collection in superficial sulci & cisterns
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D. Traumatic haemorrhagic contusion
Foci of punctate or linear haemorrhage Common at grey-white matter junction
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D.Traumatic haemorrhagic contusion
Cerebral edema
Multiple fractures
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I b. Non-traumatic intracranial haemorrhage
i) Hypertensive haemorrhage
ii) Haemorrhagic infarction
iii) Aneurysm & vascular malformation
iv) Haemorrhagic neoplasm
v) Iatrogenic
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i) Hypertensive haemorrhage
Common locations are:
• Putamen / external capsule• Thalamus• Pons • Cerebellum• Subcortical white matter
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Hypertensive haemorrhage
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Hypertensive encephalopathy
Pre-eclampsia / eclampsia (Common site is bilateral occipital region)
Chronic renal failureThrombotic thromocytopenic purpuraHemolytic uremic syndromeSLE
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ii) Haemorrhagic Infarction
Arterial Infarction
Venous Infarction
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Arterial Haemorrhagic Infarct
Common Cause of Haemorrhagic transformation is- Embolism
Post contrastPlain
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Venous Infarct
Commonly associated with venous sinus thrombosis
Hyperdense sinus - Plain CT Empty delta sign- Contrast enhanced CT
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Venous Thrombosis OR ??
50 year old lady with severe headache referred for CTA
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iii) Aneurysms
Commonest presenting symptom is SAH
Intra-ventricular breakthrough
CT angiogram is helpful to demonstrate site of aneurysm
CT Angiogram
Post clipping bleed
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iv) Vascular Malformation
Arterio venous Malformation
Cavernous angioma
Venous angioma
Capillary telangectasia
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Intra-ventricular bleed
35 year old man came with sudden loss of consciousness
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Arterio-venous malformation
CT Angiogram performed
Axial
Coronal
Sagittal
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Haemorrhagic Neoplasm
Malignancy induced coagulopathy –Leukemia
Intra-tumoral bleed : Primary
: Metastatic
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Intratumoral bleed
Common tumors are:
-Pituitary adenoma
-GBM
-Oligodendroglioma
-Ependymoma
-PNET
-Mets : Lung, renal, choriocarcinoma,
melanoma
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Bleed in GBM
45 yrs old lady operated for Ca breast ,presented with right sided weakness
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Iatrogenic Intracerebral bleed
Patient with MI – Post thrombolytic therapy, sudden loss of consciousness
Bleed in right BG