INTERPRETATION OF

CT-BRAIN
Dr Fahad Saadi
FY2 in General Surgery
fsaadi01@qub.ac.uk
Altnagelvin Hospital, Western Trust
CLINICAL INFORMATION FALL FROM HEIGHT WITH
DIRECT TRAUMA TO THE LEFT SIDE OF THE HEAD
• Extradural haematoma (EDH) with contracoup injury
• A lens-shaped collection of dense (acute) blood is the classic appearance
of an extradural haematoma (EDH)
• EDH formation commonly results from injury to the middle meningeal artery
• Post-traumatic intracranial haemorrhage at the site of impact can be
referred to as a 'coup' injury
• A coup injury may be accompanied by a 'contracoup' injury - located on
the opposite side of the brain from the site of impact
• Contracoup injuries are caused by acceleration-deceleration forces at the
time of injury
 CLINICAL INFORMATION
MEMORY LOSS FOLLOWING A FALL
• Subdural haematoma (SDH) age
• This patient with a subdural haematoma had three CT scans - one at the
time of injury, one at 1 month and another at 2 months post injury
• Initially the subdural haematoma is higher in density or 'hyperdense' (whiter)
when compared to the adjacent brain cortex
• At 1 month the collection is difficult to see because it is identical in density or
'isodense' to the adjacent brain cortex
• At 2 months the subdural is 'hypodense' (darker) when compared to the
adjacent brain cortex
ALCOHOLIC WITH POOR LIVER FUNCTION AND DERANGED CLOTTING
REDUCED CONSCIOUSNESS FOLLOWING MINOR HEAD INJURY
• Hyperacute subdural haematoma
• This crescent-shaped subdural haematoma contains mixed high density and
low density material
• The dense (white) material represents recently clotted blood
• The less dense blood (grey) is not due to a chronic haematoma, it is
hyperacute blood which has not yet had time to clot
• (The bone windows did not demonstrate a skull fracture)
SUDDEN ONSET OF SEVERE - 'WORST
EVER' - HEADACHE
• Subarachnoid haemorrhage (SAH)
• Dense material in the basal cisterns and fissures is due to acute bleeding into
the subarachnoid space
• Blood in the subarachnoid space can fill or partly fill the sulci, fissures, basal
cisterns and ventricles
 HISTORY OF HYPERTENSION
SUDDEN ONSET OF HEADACHE AND LEFT HEMIPARESIS
WORSENING LEVEL OF CONSCIOUSNESS SINCE ARRIVAL IN THE
EMERGENCY DEPARTMENT
• Large intracerebral haemorrhage (ICH)
• A large area of increased density (white) represents acute bleeding into the
brain parenchyma
• Low density surrounding the blood indicates adjacent cerebral oedema
• ICH is commonly associated with mass effect - this image shows effacement
of the sulci and ventricles, and shift of midline structures
 HISTORY OF HYPERTENSION
SUDDEN ONSET RIGHT HEMIPARESIS
• Intraventricular haemorrhage
• Intracerebral haemorrhage may extend into the CSF spaces
• In this image bleeding extends into the left lateral ventricle
 SUDDEN ONSET LEFT HEMIPARESIS
(INFARCT)
CONSCIOUS AND STABLE ON INITIAL
ASSESSMENT
RAPID UNCONSCIOUSNESS
(HAEMORRHAGIC TRANSFORMATION)
NOTE: HAEMORRHAGIC
TRANSFORMATION IS MORE COMMON
IN ANTICOAGULATED PATIENTS AND
FOLLOWING THROMBOLYSIS THERAPY
FOR AN ISCHAEMIC INFARCT
• Infarct with haemorrhagic transformation
• Intracerebral haemorrhage may occur as a complication of cerebral
infarction - a phenomenon known as 'haemorrhagic transformation'
• The large area of low density seen in the grey and the white matter is due to
a large infarct of the right middle cerebral artery territory
• The high density area within the infarct is due to haemorrhagic
transformation
DIRECT BLUNT TRAUMA TO THE RIGHT SIDE OF THE HEAD
SCALP SWELLING AND BLEEDING
• Scalp haematoma
• Swelling of the scalp soft tissues is due to formation of a haematoma
• If you see a scalp haematoma, check carefully for an underlying skull
fracture and intracranial haemorrhage - none in this case
ACUTE ONSET RIGHT HEMIPARESIS
• Acute infarct - Dense MCA sign
• The left middle cerebral artery (MCA) is very dense due to a thrombus -
compare with the density of the normal right MCA
• A dense artery sign may be seen before any change in the infarcted grey
and white matter
• Low density is already visible in the infarcted area
• Old infarct
• Several months after an acute ischaemic event the brain cells in the
infarcted area have died leaving an area of low density
• This image shows the typical appearance of an old infarct - in this case of
the right MCA territory
 REFERENCES
• https://www.radiologymasterclass.co.uk/gallery/galleries