intra cranial hematoma

Imaging in head injury

X-ray

• Detect skull fractures

• Include neck in coma

• Role is limited

CT scan

• Rapid

• Non invasive

• Bony & soft tissue injury

• Site

CT

• Nature

• Midline shifts

• Mass effect

• Presence of FB & air

Disadvantages

• Vascular lesions missed

• Artefacts

• Vertex fractures missed

• Motion can degrade images

Indications

• Coma

• No improvement

• Falling GCS

• Depressed skull fractures

• Post traumatic seizures

Indications for serial CT

• Resolution of small hematomas

• Delayed hematomas

• Post traumatic changes

• Immediate post operative - baseline

MRI

• Vascular lesions – aneurysm, ccf

• Brain stem injuries

• Axonal injuries

• Contusions, small hematomas

Disadvantages

• Expensive

• Longer imaging time

• Fractures not well seen

• SAH not well seen

Others

• EEG- seizure focus, brain death

• Ventriculography – CSF loculation ,cysts

• Angiography – vascular lesions

Indications of CT in head injury

• Skull fracture with

confusion & altered LOC

FND

seizures


• Without skull fracture

persistent confusion

impaired LOC after resuscitation


• Deteriorisation of LOC

• Depressed skull fractures

• Penetrating / open skull fractures

• Uncertain diagnosis

• Tense frontanelle

Intra cranial hematoma

Acute SDH

Source

• Parasagittal bridging veins

• They drain the surface to dural sinuses

• Associated paranchymal injury

SDH

• Level of consciousness

• Anisocoria

• Motor deficit

Anisocoria

• Ipsilateral to pupillary dialatation

• Opposite to motor deficit

SDH

• A/C

• Sub a/c

• c/c

A/C

• 2-3 days

• Hyperdense in CT

• c/f resemble a/c EDH

• Common in young

CT

• Crescendic

• Laculnar

• concavoconvex

Treatment

• Conservative

• Surgical

conservative

• Size 4mm shift, 8mm size

• Site – temporal tip

• GCS

Surgery

• Craniotomy

• evacuation

Sub a/c

• 2-3 wks

• Isodense

• MRI

C/C

• Similar to mass lesion

• Old age

• May not remember injury

• Less symptoms

• Large lesion

• Brain atrophy

Investigation

• CT

• Hypodense lesion

Treatment

• Conservative

• Surgery

Surgery

• Craniotomy

• Burr hole

Education