GEMC: Systematic Evaluation to Non-Traumatic Head CTs: Resident Training

50 %
50 %
Information about GEMC: Systematic Evaluation to Non-Traumatic Head CTs: Resident Training
Education

Published on March 2, 2014

Author: openmichigan

Source: slideshare.net

Description

This is a lecture by Dr. Rashmi U. Kothari from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.

Project: Ghana Emergency Medicine Collaborative Document Title: Systematic Evaluation to Non-Traumatic Head CTs Author(s) Rashmi U. Kothari, MD (KCMS/MSU), 2012 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/ We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly shareable version. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact open.michigan@umich.edu with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit http://open.umich.edu/privacy-and-terms-use. Any medical information in this material is intended to inform and educate and is not a tool for selfdiagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers. 1

Attribution Key for more information see: http://open.umich.edu/wiki/AttributionPolicy Use + Share + Adapt { Content the copyright holder, author, or law permits you to use, share and adapt. } Public Domain – Government: Works that are produced by the U.S. Government. (17 USC § 105) Public Domain – Expired: Works that are no longer protected due to an expired copyright term. Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain. Creative Commons – Zero Waiver Creative Commons – Attribution License Creative Commons – Attribution Share Alike License Creative Commons – Attribution Noncommercial License Creative Commons – Attribution Noncommercial Share Alike License GNU – Free Documentation License Make Your Own Assessment { Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. } Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (17 USC § 102(b)) *laws in your jurisdiction may differ { Content Open.Michigan has used under a Fair Use determination. } Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (17 USC § 107) *laws in your jurisdiction may differ Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair. 2 To use this content you should do your own independent analysis to determine whether or not your use will be Fair.

Systematic Evaluation to Non-Traumatic Head CTs Source Undetermined Rashmi U. Kothari, MD KCMS/MSU

Why do you need to be able to evaluate a CT Ø  Radiology report is not immediately available Ø  Need immediate intervention Ø  Don’t trust anyone

Course Outline Ø  Basic principles of CT Ø  Basic anatomy Ø  Systematic Ø  CT approach Potpourri

Course Goals Ø  Learn “Blood Can Be Very Bad” approach to reading CTs Ø  Identify classic CT findings

Disclaimer Ø  Make you a neuroradiologist Ø  Teach you cause of finding of abnormality Ø  Help you with contrast CTs

Source Undetermined Basic Principles of CT Imaging

X-rays Absorbed Differently by Different Tissues Radiolucent Radiodense Air Bone Spinal fluid Source Undetermined Metal Ischemic infarct Calcium Edema Blood White matter Grey matter Source Undetermined

Attenuation (amount of radiation blocked by tissue) 50-100 HU Air Blood -1000 HU Bone +1000 HU HU=Hounsfield Units

Windowing Ø  Blood Source Undetermined Source Undetermined Source Undetermined Brain Blood Bone

CT Anatomy Source Undetermined Ø  Six levels of cuts Ø  Cortical sulci Ø  Lateral Ventricles Ø  Basal Ganglia Ø  3 rd Ventricle Ø  Midbrain Ø  Pons Source Undetermined

CT Anatomy: Cortical Sulci & Lat. Ventricle Falx Cortical sulci Source Undetermined Source Undetermined Frontal lobe Parietal lobe Lateral ventricles Occipital lobe Source Undetermined Source Undetermined

CT Anatomy: Basal Ganglia & 3rd Ventricle Anterior horns . Choroid plexus Source Undetermined Source Undetermined Anterior horns Insular ribbon Sylvian fissure 3rd ventricle Quadrigeminal cistern Source Undetermined Source Undetermined

CT Anatomy: Midbrain & Pons Sylvian fissure Insular ribbon Ambient cistern (cirummesenphalic cistern) Source Undetermined Source Undetermined Frontal sinus Suprastellar cistern Pons 4th ventrical Source Undetermined Source Undetermined

Systematic Approach to Head CTs Ø P erron et al: Carolina’s Medical Center Ø “ Blood Can Be Very Bad” pnemonic Ø C ourse reviewing 12 scans & short histories Ø P re-test 60% to Post-test 78% Ø h ttp://www.uic.edu/com/ferne/pdf/acep_2005 _peds/perron_ich _acep_2005_peds_ course.pdf

“Blood Can Be Very Bad” Ø  Blood Ø  Cisterns Ø  Brain Ø  Ventricles Ø  Bone Perron et al: Ann Emerg Med 1998:32:554-562

“Blood Can Be Very Bad” Ø  Acute blood = hyperdense (white) Ø  50-100 Ø  As Ø  At HU it ages it becomes hypodense 1-2 weeks it is isodense with brain

“Blood Can Be Very Bad” Source Undetermined Source Undetermined Source Undetermined

“Blood Can Be Very Bad” Ø  4 cisterns: Suprasellar Ø  Quadrigeminal Ø  Slyvian Ø  Ambient Ø  Source Undetermined Source Undetermined Source Undetermined

Cisterns: Is there blood? Source Undetermined Source Undetermined Are they open? 21 Andrew D. Perron, MD, FACEP

“Blood Can Be Very Bad” Source Undetermined Source Undetermined Brain Source Undetermined

“Blood Can Be Very Bad” Source Undetermined Source Undetermined Source Undetermined Ventricle Source Undetermined

“Blood Can Be Very Bad” Source Undetermined Bone Source Undetermined Andrew D. Perron, MD, FACEP

Source Undetermined Source Undetermined Classic CT Findings Source Undetermined Source Undetermined Source Undetermined

Epidural •  Lens shape •  85% arterial bleeds •  Middle meningeal art • Lucid period Source Undetermined Subdural •  Concave shape •  Venous bleeds •  Crosses suture line Source Undetermined

Intracerebral Hemorrhage q  10% of all strokes Source Undetermined Source Undetermined q  2 major causes q  Hypertension q  Blacks & Asians q  50% basal ganglia q  Pons q  Cerebellum q  Amyloid q  Caucasians q  Lobar q  Recurrent

Subarachnoid Hemorrhage q  5-10% of all strokes q  Aneurysms, AVMs, trauma q  Hyperdense, fuzzy q  Locations of blood C- Source Undetermined – Sulci – Sylvian fissure – Circle of Willis – Falx – Tentorium

ICH Source Undetermined Source Undetermined SAH Normal Source Undetermined Source Undetermined SAH ICH Source Undetermined Source Undetermined SAH

Findings Suggestive of ICH Ø N ormal Calcification Ø  Basal ganglia Ø  Choroid plexus Ø  Pineal gland CSource Undetermined

Findings Suggestive of ICH Ø Metal Ø  Very hypodense Ø  “Sparks” Ø  Clips, bullets, metallic catheters CSource Undetermined

Findings Suggestive of ICH ? CSource Undetermined

Volume Averaging (Technical Issues Mimicking ICH) Ø  Orbital roof Ø  Petrous portion of temporal bone Ø  Pituitary fossa Ø  Brainstem Source Undetermined Source Undetermined Source Undetermined

Findings Suggestive of ICH/SAH ? ? CSource Undetermined

Motion Artifact (Technical Issues Mimicking ICH or SAH) Ø Streaky Ø Hyperdense Ø Boney prominence Source Undetermined Source Undetermined

Evolution of an Infarct Source Undetermined Source Undetermined Ultra-Acute Acute-Subacute 0-3 hours 6hrs-days Source Undetermined Chronic 1 year

Ultra-Early CT Findings Ø  Normal Ø  Sulcal effacement Ø  Loss of insular ribbon Ø  Loss of grey-white interface Ø  Acute hypodensity Source Undetermined

Sulcal Effacement Source Undetermined Source Undetermined

Loss of Insular Ribbon Source Undetermined

Loss of Sulci & Acute Hypodensity Source Undetermined

Acute Hypodensity Source Undetermined Source Undetermined

Acute-Subacute Stroke (hours-days) Ø  Hypodense Ø  Well demarcated Ø  Mass effect Ø  Midline shift Ø  Loss of sulci Source Undetermined

Old Infarct (months to years) Ø  Density of CSF Ø  Well demarcated Ø  Ventrical enlargement Ø  Sulci enlargement Ø  No sulcal effacement Ø  No mass effect Source Undetermined

Suggestive of an Infarct? Source Undetermined

Suggestive of an Infarct? Source Undetermined Tumor Source Undetermined Stroke

Case Presentations

Thalamic ICH Source Undetermined

Normal Source Undetermined

Chronic Frontal Subdural Source Undetermined

Subacute Right Parietal Infarct Source Undetermined

Source Undetermined continued

Source Undetermined SAH Source Undetermined Normal

Acute Subdural Source Undetermined

Normal Source Undetermined

Closed Ventricles Source Undetermined

Cisterns: Are they open? Source Undetermined Source Undetermined Andrew D. Perron, MD, FACEP

Metallic Artifact Source Undetermined

Brainstem SAH Source Undetermined

Chronic MCA Infarct Source Undetermined

Left IVH Source Undetermined

Epidural Source Undetermined

Rt Subacute Epidural Source Undetermined

Sagital Sinus Source Undetermined

Subacute Infarct Source Undetermined

Renal Cell Metastasis Source Undetermined

Source Undetermined continued

Source Undetermined SAH Source Undetermined Normal

48 hr old Right Temporal Infarct Source Undetermined

Acute on Chronic Subdural Source Undetermined

Source Undetermined

Source Undetermined Source Undetermined SAH Source Undetermined Source Undetermined

Rt Parietal Fx with Air Source Undetermined

Source Undetermined

Brain Abscess Source Undetermined

Calcification Basal Ganglia Source Undetermined

Source Undetermined

Source Undetermined continued

hours 3-4 days Source Undetermined Source Undetermined months 7-10 days Source Undetermined Source Undetermined

Trauma with Air Source Undetermined

Dense MCA Sign Source Undetermined

Subacute Brainstem Infarct Source Undetermined

Atrophy Source Undetermined

Trauma with SAH Source Undetermined

Bitemporal Edema (Herpes) Source Undetermined

Meningioma Source Undetermined

Caudate Infarct Source Undetermined

IVH Left Lateral Horn Source Undetermined

Ultra-Early Right Parietal Infarct Right Sulcal Effacement Source Undetermined

Source Undetermined Continued

Source Undetermined Source Undetermined Source Undetermined Source Undetermined Source Undetermined Source Undetermined

Subacute Infarct (Rt Temporal Lobe) Source Undetermined Source Undetermined

Periventricular White Matter Disease Source Undetermined Source Undetermined

Chronic Rt Occipital Infarct Source Undetermined Source Undetermined Source Undetermined

Subacute Subdural Source Undetermined

Traumatic Petechae Source Undetermined

Loss of Sulci & Sylvian Fissure Source Undetermined

Old Lt Lacunar Infarct Source Undetermined

Subacute Lt Subdural Source Undetermined

Rt MCA Infarct with Hemorrhage Source Undetermined

Lt Sagital Vein Thrombosis Source Undetermined

Source Undetermined

SAH with Blood along Falx & in Ventricle Source Undetermined

Tumor Source Undetermined

Tumor Source Undetermined

CT Ground Rule Radiolucent Radiodense Spinal fluid Bone Ischemic infarct Blood Source Undetermined Edema Calcium White matter Grey matter Air Metal Source Undetermined

“Blood Can Be Very Bad” Ø  Blood Ø  Cisterns Ø  Brain Ø  Ventricles Ø  Bone Perron et al: Ann Emerg Med 1998:32:554-562

Intracerebral Hemorrhage q A ppearance q Hyperdense q Well demarcated q Globular q L ocation q Intraparenchymal Source Undetermined q M imics q Normal Calcification q  Basal ganglia q  Choroid plexus q  Pineal gland q Artifacts q  Metal q  Catheters q  Volume Averaging q  Motion

Subarachnoid Hemorrhage q  Appearance q  Hyperdense q  Fuzzy q  Locations of blood q  Mimics q  Contrast q  Calcified Falx q  Normal Tentorium q  Motion artifact q  Sulci q  Sylvian fissure q  Circle of Willis q  Falx q  Tentorium Source Undetermined

Ultra-Early Infarct Old Infarcts Normal Density of CSF Sulcal effacement Well demarcated Loss of insular ribbon Ventrical enlargement Loss of grey-white interface Sulci enlargement Acute hypodensity Source Undetermined No sulcal effacement No mass effect Acute-Subacute Hypodense Well demarcated Mass effect Midline shift Loss of sulci Source Undetermined Source Undetermined

Add a comment

Related presentations

Related pages

GEMC: Non-Traumatic Abdominal Pain/Abdominal Emergencies ...

Share GEMC: Non-Traumatic Abdominal Pain/Abdominal Emergencies: Resident Training. ... Systematic Evaluation to Non-Traumatic Head CTs: ...
Read more

GEMC - Non-Traumatic Abdominal Pain/Abdominal Emergencies ...

Share GEMC - Non-Traumatic Abdominal Pain/Abdominal Emergencies- Resident Training. ... Systematic Evaluation to Non-Traumatic Head CTs: ...
Read more

Resident Training | LinkedIn

Resident Training. Articles, experts, jobs, and more: get all the professional insights you need on LinkedIn. ... MD, Resident in training (AIOS) ...
Read more

Weakness a Systematic Approach to Acute Non-Traumatic N

Weakness a Systematic Approach to Acute Non-Traumatic N ...
Read more

Cts I | LinkedIn

Cts I. Articles, experts, jobs, and more: ... Senior Consultant at CTS, Inc., Wedding Violinist at Fafach Inc Past Speaker at NSBCon, 2015 at CTS, Inc., ...
Read more

emergency medicine consensus: Topics by Science.gov

Sample records for emergency medicine consensus ... resident wellness, and the resident training ... on the systematic approach of the evaluation and ...
Read more

Nontraumatic Orthopaedic Emergencies - Documents

1. Nontraumatic Orthopedic Emergencies . 2. Objectives • Understand the pathophysiology of nontraumatic orthopedic conditions. • Describe the ...
Read more