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HEAD AND CERVICAL SPINE - Emergency Radiologic Approach - Ranieri Falcão Aguiar Radiology Fellow Radiology Department Sir Charles Gairdner Hospital 12-06-2014

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Head and cervical spine imaging

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Page 1: Head and cervical spine imaging

HEAD AND CERVICAL SPINE- Emergency Radiologic Approach -

Ranieri Falcão AguiarRadiology Fellow

Radiology DepartmentSir Charles Gairdner Hospital

12-06-2014

Page 2: Head and cervical spine imaging

Head ct - approach

1. Midline2. Symmetry3. Basal cisterns4. Ventricles

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 3: Head and cervical spine imaging

Head ct - approach

1. Midline2. Symmetry

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 4: Head and cervical spine imaging

Head ct - approach

1. Midline2. Symmetry3. Basal cisterns

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 5: Head and cervical spine imaging

Head ct - approach

1. Midline2. Symmetry3. Basal cisterns

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 6: Head and cervical spine imaging

Head ct - approach

1. Midline2. Symmetry3. Basal cisterns4. Ventricles

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 7: Head and cervical spine imaging

Head ct - approach

1. Midline2. Symmetry3. Basal cisterns4. Ventricles

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 8: Head and cervical spine imaging

Head ct - approach

1. Midline2. Symmetry3. Basal cisterns4. Ventricles

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 9: Head and cervical spine imaging

Head ct - approach

1. Midline2. Symmetry3. Basal cisterns4. Ventricles

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 10: Head and cervical spine imaging

Head ct - approach

1. Midline2. Symmetry3. Basal cisterns4. Ventricles

EMERGENCY CT CHECKLIST1.Is the middle of the brain in the middle of the head?2.Do the two sides of the brain look alike?3.Can you see the smile and the pentagon or Jewish star?4.Is the fourth ventricle in the midline and more or less symmetrical?5.Are the lateral ventricles huge, with effaced sulci?

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 11: Head and cervical spine imaging

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 12: Head and cervical spine imaging

What to look for?• Fractures• Calvarium• Skull base• Orbit• Facial bones

• Hemorrhage• Epidural hematoma• Subdural hematoma• Subarachnoid• Intraventricular• Intracerebral hematoma

• Cortical contusions• Diffuse axonal injury

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 13: Head and cervical spine imaging

fractures

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 14: Head and cervical spine imaging

fractures

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 15: Head and cervical spine imaging

Epidural hematomas

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 16: Head and cervical spine imaging

Subdural hematomas

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 17: Head and cervical spine imaging

Subdural hematomas

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 18: Head and cervical spine imaging

Subdural hematomas

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 19: Head and cervical spine imaging

Subdural hematomas

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 20: Head and cervical spine imaging

Subarachnoid hemorrhage

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 21: Head and cervical spine imaging

Diffuse axonal injury

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 22: Head and cervical spine imaging

Cortical contusions

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 23: Head and cervical spine imaging

CERVICAL SPINE

Page 24: Head and cervical spine imaging

Cervical spine - RADIOGRAPHS

STANDARD VIEWS•Lateral

•Antero-posterior

•Open mouth

Page 25: Head and cervical spine imaging

CERVICAL SPINE - ANATOMY

• SPECIFIC ANATOMY• C1• C2• SUBAXIAL

SPECIFIC FRACTURES

Page 26: Head and cervical spine imaging

Diag. and Surgical Imaging Anatomy Brain, Head&Neck, Spine. 2006

Page 27: Head and cervical spine imaging

Diag. and Surgical Imaging Anatomy Brain, Head&Neck, Spine. 2006

Page 28: Head and cervical spine imaging

Diag. and Surgical Imaging Anatomy Brain, Head&Neck, Spine. 2006

Page 29: Head and cervical spine imaging

Diag. and Surgical Imaging Anatomy Brain, Head&Neck, Spine. 2006

Page 30: Head and cervical spine imaging

Diag. and Surgical Imaging Anatomy Brain, Head&Neck, Spine. 2006

Page 31: Head and cervical spine imaging

Diag. and Surgical Imaging Anatomy Brain, Head&Neck, Spine. 2006

Page 32: Head and cervical spine imaging

Diag. and Surgical Imaging Anatomy Brain, Head&Neck, Spine. 2006

Page 33: Head and cervical spine imaging

Diag. and Surgical Imaging Anatomy Brain, Head&Neck, Spine. 2006

Page 34: Head and cervical spine imaging

Diag. and Surgical Imaging Anatomy Brain, Head&Neck, Spine. 2006

Page 35: Head and cervical spine imaging

X-ray adequacy

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 36: Head and cervical spine imaging

alignment

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 37: Head and cervical spine imaging

Diag. and Surgical Imaging Anatomy Brain, Head&Neck, Spine. 2006

Page 38: Head and cervical spine imaging

alignment

Page 39: Head and cervical spine imaging

distances

Fundamentals of Diagnostic Radiology, 3rd ed.

Page 40: Head and cervical spine imaging

distances

Fundamentals of Diagnostic Radiology, 3rd ed.

ABOVE C4 < 1/3rd OF VERTEBRAL BODY

BELOW C4 < 1 VERTEBRAL BODY

*NOT SENSITIVE

Page 41: Head and cervical spine imaging

distances

Page 42: Head and cervical spine imaging

ROTATED

Page 43: Head and cervical spine imaging

TEARDROP FRACTURE

A-Z of Emergency Radiology, 1st ed. 2004

Page 44: Head and cervical spine imaging

JEFFERSON’S FRACTURE

A-Z of Emergency Radiology, 1st ed. 2004

Page 45: Head and cervical spine imaging

HANGMAN’S FRACTURE

A-Z of Emergency Radiology, 1st ed. 2004

Page 46: Head and cervical spine imaging

LOCKED FACETS

A-Z of Emergency Radiology, 1st ed. 2004

Page 47: Head and cervical spine imaging
Page 48: Head and cervical spine imaging

C-spine

TO SUM UP

1.3 STANDARD VIEWS2.XRAY QUALITY3.ALIGNMENT 3 LINES4.FOLLOW BONE CORTICES5.DISTANCES• ATLANTO-DENS INTERVAL• PRE VERTEBRAL SOFT TISSUE• C1 LATERAL MASSES (OPEN MOUTH VIEW)• SPINOUS PROCESS AND DISK SPACES

6.CT7.MRI LIGAMENTOUS OR MEDULLARY INJURIES

Page 49: Head and cervical spine imaging

THANK YOU!


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