The Head CT.

Phil Singer, EM1

History of the CT
1970- Sir Jeffrey Hounsfeld combined a
mathematical reconstruction formula with a
rotating apparatus that could produce and
detect x-rays... this became the modern day CT
scanner.. He was knighted for this
accomplishment.
Why talk about head CTs.
1. Most of us have to overlook a head CT.
2. We use night hawks.
3. Many studies have shown that there are
huge deficiencies in the ability to accurately
read a head CT.
Purpose of this discussion.
To explain and demonstrate a methodical
approach to reading head CTs for acute
intracranial emergencies and non-emergencies.
- Test your learning by active question and
answer.
Pertinent Anatomy
Posterior Fossa
Pertinent Anatomy
Low Cerebellum
Pertinent Anatomy
High Pons
Pertinent Anatomy
Cerebral Peduncle
Pertinent Anatomy
Basal Ganglia
Pertinent Anatomy
High Midbrain
Pertinent Anatomy
Lateral Ventricles.
Pertinent Anatomy
Upper Cortex
Blood Can Be Very Bad.
Methodical approach to reading head CTs
developed by Andrew Perron, MD, FACEP.

Blood.
BloodAcute hemorrhage appears hyperdense (bright
white) on CT.
Acute blood 50 to 100 HU
Can
CisternsCerebrospinal fluid collections jacketing the
brain; the following four key cisterns must be examined
for blood, asymmetry, and effacement (representing
increased intracranial pressure):
- Circummesencephalic
- Suprasellar
- Quadrageminal
- Sylvian
Can
CSF Flow:
Lateral ventricles (Choroid plexus) >IIIrd Ventricle >
Aqueduct of Sylvius > IVth Ventricle > Magendie and
Lushka > Subarachnoid space.
0.5-1cc/minute in adults.
Adult CSF Volume = 150cc
Adult CSF Production 500-700 cc/day (i.e. CSF turns over
3-5 times/day)
Cisterns
Suprasellar (star-shaped)Location of the circle of Willis;
frequent site of aneurysmal subarachnoid
hemorrhage
Cisterns
CircummesencephalicCerebrospinal fluid ring around
the midbrain; first to be effaced with increased
intracranial pressure
Cisterns
Sylvian-Between temporal and frontal lobes; site of
traumatic and distal mid-cerebral aneurysm and
subarachnoid hemorrhage
Cisterns
QuadrigeminalW-shaped cistern at top of midbrain;
effaced early by rostrocaudal herniation
Be
Brain-
-Symmetry
-Gray-White Differentiation
-Shift
-Hyper/Hypodensity
Very
Ventricles
-hydrocephalus
-compression/shift
Bad
Bone-
-Symmetry
-Blood in
mastoids
Subdural Hematoma
Epidural Hematoma
Orbital Blowout FX
Pontine Hemorrhage
Subarachnoid
Toxoplasmosis
Toxoplasmosis
References
Blood Can Be Very Bad
http://www.uic.edu/com/ferne/pdf/acep_2005_peds/perron_ich_acep_2005_peds_course.
pdf
Computed Tomography (CT) Angiography (Angiogram)
http://www.radiologyinfo.org/en/info.cfm?pg=angioct