z

How to Read
Brain CT Scan
dr,. Elric B. Malelak, Sp.BS

Department of Neurosurgery, Prof Dr. W.Z. Johannes

Regional General Hospital, Kupang, East Nusa Tenggara, Indonesia
 z Basic Principles of CT Scan

 Invented by Sir Godrey Hounsfield

 Uses X rays applied in sequence of

slices across the organ

 Images reconstructed from X ray

absorption data

 X ray beam moves around the

patient in a circular path
z
 z Basic Principles of CT Scan

 CT Scan provide a 3D display of

the intracranial anatomy built up
from a cervical series of
transverse axial tomograms

 Each tomogram represents a

horizontal slice through the
patients head

 Slice thickness may vary, but in

general,it is between 5 dan10mm
for a routine head CT
 z Basic Principles of CT Scan
 Always describe CT findings as densities:

isodense/hypodense/hyperdense

 Higher the density = white is appearance

 Lower the density = darker the appearance

 Brain is the reference density

 Anything of the density as brain = isodense

 Higher density than brain= hyperdense (skull is the best example)

 Anything darker (lower density) than brain= hypodense (CSF and air are
classical example)
z
Hounsfield Unit
z Densities of CT Scan
 z

Normal Neuroanatomy As Seen on

Head CT Scans
 z Axial sections of CT Head

 Posterior Fossa Cuts

 Above the Foramen Magnum Level
 Level of the Fourth Ventricle
 Above the Fourth Ventricular Level
 Tentorial

 Supratentorial Cuts
 Third Ventricular Level
 Lateral Ventricular Level
 Above the Ventricular Level
z Normal Anatomy
z Normal Anatomy
z Normal Anatomy
z Normal Anatomy
z Normal Anatomy
z Normal Anatomy
z Normal Anatomy
z Normal Anatomy
z
z
z
z Physioloical Calcifications
 z

Traumatic brain injury on CT Scan

 Traumatic
z Brain Injury (TBI)

 Leading cause of death and disability

 Mortality related to Glasglow Coma Scale (GCS)

Closed or Open TBI ?
z
z Primary or Secondary TBI ?
z
 z

Skull Fracture
 z Quick Anatomy

 3 layers
 Outer table
 Diploe
 Inner table

 Parts without diploe prone to fracture

 Squamous temporal / parietal bone
 Foramen magnum, skull bases, cribiform plates, orbital roof
 z Types Of Skull Fractures

 Linear fracture (with/without subdural hematoma / epidural hematoma)

 Depressed Fracture

 Skull Base Fracture

 Open Head Injuries

 Knife, firearm
 Laceration of dura
 z Depressed Skull Fracture

 Criteria to Elevate:

 >= 8-10 mm depression

 Deficit related to underlying brain

 CSF leak
 z

Intracranial Haemorrhage (ICH)

 z Intracranial Haemorrhage (ICH)

 Parenchymal vessel rupture from

blunt or penetrating forces

 May not lose consciousness

 Hematoma at primary trauma site

(usually frontal and temporal)
 z Intracranial Haemorrhage (ICH)

 Well-circumscribed hyperdense
lesion w/wo perilesional edema

 With / without SDH, EDH, IVH

 Hematoma at primary trauma site

(usually frontal and temporal)
 z

Epidural Hematoma (EDH)

 z Epidural Hematoma (EDH)

 Hematoma between inner table

of the skull and dura

 Most common sourve of bleeding

= middle meningeal artery

 Most urgent of all cases of cranial

trauma

 Lucid interval may present

Epidural
z Hematoma (EDH)

 Biconvex or lens shape

hyperdense lesion

 May cross midline and dural

attachment

 Do not cross suture (except

diastatic fracture, large EDH)
 z Swirl Sign

Small rounded lesion

isodense to the brain,
representing active
extravasation of unclotted
blood
 z

Subdural Hematoma (SDH)

 z Subdural Hematoma (SDH)

 Blood collects between dura

and arachnoid

 Torn bridging veins

 z Subdural Hematoma (SDH)

 Usually co-exist with other

brain injuries

 Crescentic hyperdense
collection

 Can cross suture

 Isodense subdural Hematoma
z

 Subacute SDH

 Anemic patients can

present with acute
isodense SDH
 z Acute on Chronic SDH

 New Hemorrhage superimposed

on chronic SDH

 Recurrent trauma

 Can be spontaneous

 Blood-fluid level, blood clot

organization, membranes
z Comparison of EDH and SDH
z
 z Bibliography

 Mark S Greenberg. Handbook of Neurosurgery. 2020. Thieme Medical Publishers.

Inc

 William E. Brant. Fundamentals of diagnostic Radiology. 2012. Lippincott Williams &

Wilkins

 Kumar et al, Basic Pathology 7E