BRAIN- CT Flashcards by JHope .

Pt needs an XRAy of skull from head trauma. What are reasons for skull XR?

**RARE to order
AP, lateral view
Foreign body
Child abuse
Mets, Multiple Myeloma

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In order to view maxillary sinuses which Xray technique is required?

Towne

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If you suspect a CVA, what type of CT is needed first?

CT w/o contrast

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What are indications for CT?

Head trauma (clinically significant)
Headache (atypical, worst ever)
Delirium (unexplained)
HA + fever (meningitis, abscess, enceph)
Seizure (1st ever)
Vertigo w/ central sx
Coag + trauma (old ppl on Coumadin!)
Cancer Hx + new HA, ALOC, focal neuro
Vomiting in absence of abdominal sx
Child abuse

BLOOD CAN BE VERY B*AD
check, blood, cisterns, brain, ventricles, bone

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What is normal regarding these structure on CT w/o contrast?

Basal ganglia calcifications
Pineal gland
choroid plexus
Pituitary

Normal HYPERattenuation (white)

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What is abnormally white and black on CT With contrast?

Abnormal white things:
Blood
Tumor/ mass/ infxn
Abnormal dark things
Air, edema, ischemia

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In order to determine the following what image is advantagous?
Vascular lesions
Arteriovenous malformation, aneurysm
Tumors (ring-enhanced lesion)
Brain abscess (ring-enhanced lesion)

CT Contrast

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What is considered abnormal on CT w/ contrast?

White things:

Abnormal meningeal uptake –peripheral enhancement of edema
Fresh bleeding
“ring enhancement” of tumors, infxn

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IF the following is suspected what is ideal imaging:
CVA -Early 
Meningioma
Neuro deficits- MS  
Axonal injury
Cerebellar lesions

MRI
No radiation
T1- fluid black, T2 fluid white
Gladolium contrast avail
NO ACUTE CVA d/t instablity

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When looking at the AP for XR, what can you see posteriorly?

Occipital and Lambdoid sutures
AP- cassette at back beam face pt, seeing Posterior
PA- cassette at front beam face back, seeing Anterior

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If you see the following on a CT, then what level is this?
Eye
Sphenoid sinus
Temporal bone
Mastoid air cells
Pons
4th ventricle-post and inf
Cerebellum

Inferior

Close to base of skull

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Trauma in this area can cause epidural bleed due to what?

Pterion- merge of sutures
Thinnest part of sckull
MCA runs here

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How should the systematic approaches be for CT?

Name
Symmetry
Densisty
Lucenty
Blood- new or old
Ischemia
Infarct
Edema
Tumors, mets
Hydrocephlus
Bony windows

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ON the brain CT, what is normal grey and darker grey?

White matter- dark grey contain myelin
INT

Gray- Grey matter- cell bodies, EXT

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What can be seen at the midbrain slice?

Frontal lobe
**Sylvian fissure- PAIR lateral
Temporal lobe
Suprasellar cistern- middle, pituitary
Midbrain
4th ventricle- post
Cerebellum

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This can be seen at within the MOST important view, SMILEY FACE.

Superior sagittal sinus (in falx)- forehead
Lateral ventricles (frontal and occipital horns)-EYES
3rd ventricle- NOSE
4th ventricle- Mouth
cerebellum- chin
Mid superior up

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These are seen at what level.
Lateral ventricles- longer, darker

Caudate nucleus -abutting frontal part of lateral ventricle, light grey

Internal capsule – anterior & posterior limbs (the white matter bw insula & basal ganglia)- thickened canal. cheek crease

Putamen (part of lentiform nucleus)- lateral to capsule

3rd ventricle- NOSE

Quadrigeminal cistern - CHIN-, replace 4th ventrical(posterior to colliculi)
Cerebellar vermis

Thalamus- medial to capsule, CHEEKS

Corpus callosum- EYEbrow togther

EVIL face

Basal Ganglia level

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What are the darker grooves and the tissue btwne the grooves?

GYRI- tissue wormy like

SULCI- tunnel spaces

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Describe the pattern of menigies in CT and MRI?

Superficial to Deep
Dura Mater- on the skull , 2
Arachonoid- weblike btwn dura and pia. Sub
PIA mater- on the brain tissue

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What are the phases of blood attenuation on CT?

Acute bleed- hypER- white

Subacute -isodesne- same color

Chronic hypO- Darker grey

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Describe each soft tissue structure normal seen on CT.

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CSF → hypoattenuated

Bone, calcifications →hypERattenuated

Vascular structures →HYPER- BLACK if no blood or blocked
AA- MCA, ACA, PCA, VBA

What should be examined b4 any DX of skull on CT?

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Bony window

Suture(sutures have cortical bone on joint surfaces)

Mrs. Happy has shoulder pain, what image is appropriate?

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MRI, but relative risk d/t Gadlonium contrast

Mrs. KFC has CR 1.8, w/ BUN <20:1. What is not allowed?

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MRI w/ contrast
Unstable pt
Hepatorrenal dfx

After symmetry, and attenuatin is examined what is next to examine on CT brain?

Brain atrophy- wider sulci, space btwn skull Midline shift- mm Cerebral edema Cerebral mass Pneumocephalus- air, black dots

Since the skull is box, but a bleed occurs what happens to structures intracranially?

MIDLINE shift- structures like lateral seen clearly but pushed over Examine- Falx (sicklelike) cerebri EFFACement- squishes structures, CANNOT be seen clearly

Encephalomalacia looks like what on CT?

``` Darker area, that isn't normally dark softening of brain tissue 1. infarct 2. infx 3. trauma ```

What is a type of hydrocephalus, dilated ventricles, when the **ENITRE ventricle and 4th ventricle is enlarged?

Communicating HYDROcephalus | Extravasuclar cause, dec reabsorption of CSF

If your grandparent has acute, gait disturbance, dementia, incontinence. Then what should be ordered?

``` **Normal Pressure Hydrocephalus- COMMUNICATING HYDRO CT brain gyri/sulci are normal 4th Ventricle enlarged ```

If the all the ventricles are enlarged except the 4th ,what is suspected?

NON Communicating HYDROcephalus | Obstruction of outflow of CSF, tumor, mass

After, IV and treatment post head trauma, what are key findings to R/o on CT?

``` Subdural hematoma Epidural hematoma Intracerebral Hemorrhage Cerebral contusion Skull FX ``` ``` REASONS to order NON Contrast 1st Neuro finding Glasco <8 LOC Wounds Vomiting w/ no Abdominal and post trauma-epidural MC ```

On the head trauma case, there is a crescent/concave shape hyperattenueted and diminished ventricle?

``` SUBDURAL Less bad d/t VENOUS orgin, slow bleed BTWN dura and arachnoid Does not cross midline May cross sutures Acute subacute chronic ```

On the head trauma case, there is a biconvex/oval shape hyperattenueted and and a midline shift?

``` EPIDURAL- dura and skull ACUTE confined due to not crossing sutures W/ skull FX Loss of gyri culci Midline shift effacement Pneumocephalus ```

What is the story with epidural?

Pt trauma, LOC, THEN wakes up ok, but risk of herniatio

What is reason to not have contrast on acute head trauma?

SUBARACHONOID HEMORRHAGE 1. cisterns and sucli- white 2. Effacement Thunderclap worse HA Eti- **#1 Trauma, aneurysm, AVM, tumor hyperattenation on NON con CT IF contrast all white, CAN miss BLEED

What will reveal axonaly injury?

MRI

If a suspected CVA is indicated, what is FIRST?

NON CONTRAST CT <6H ischemia does show IF stable, MRI is ideal

What occurs weeks after CVA on CT?

HYPO attenuated fluid | INFarts seen in region

What should be ordered for worst headache of life, women, obese, young w/ VA changes, n/v?

CT | BIH/pseudotumor

What type of CT abnormalities are common in htn, DM, atherosclerosis?

Lacunar infarcts- darkened spots, often found incidentally in basal ganglia, pons MRI- T2 infarcts will be white MRI- T1 infarct will be BLACK

What cause ICP and is seen on NON CONT CT?

Mass, blood edema, hydrocephalus | SX- HA, vomiting, papilledema, LOC

What are indicators of cerebral edema?

Effaced gyri sulci Undistinguished grey and white matter Ventricles compressed Global or local

What are causes of cerebral edema?

Infx Trauma Toxic Psuedotumor

What is HypOattenuated RING around infxn, malignancy, acute hemorrhage and ONLY Affects **white matter location?

Vasogenic Cerebral Edema | +/- Midline shift

What is hypOattenuated REGION where ischemia occurred. May see watershed/trickl effect point of infarct. Which region is often seen?

CYTOTOXIC cerebral Edema | affect ***BOTH white and grey matter.

PT C/C mild weakness in arms? What is on DDX

CVA Signs on NON con CT 1. Hyperdense vessel sign at MCA 2. Loss of “insular ribbon” (the white matter between insular cortex & nuclei) 3. Lentiform & caudate nucleus NOT distinguishable -loss of white matter btwn the two 4. Effacement of sulci

Tumors such as glioma, astrocytoma are common where?

intra-axial w/in parenchymal

Menigioma, acousti neuroma are seen where?

extra-axial invasion

What is round multiple and enhanced with contrast?

Metastases

What tapeworm common in uncooked pork, what will have vasogenic edema surrounding it? Curable

Neurocysticercosis | multiple cyst ring-like lesions in brain

BRAIN- CT Flashcards

(50 cards)