Imaging of traumatic brain injury

Question 1

Types of brain injury

Answer 1

Closed

Open

Question 2

Closed TBI

Answer 2

Dura intact
More common
Violent acceleration

Question 3

Open TBI

Answer 3

Dura disrupted
Less common
Fracture or FB penetrating dura

Question 4

Coup is an injury at the ………… side

Countercoup is an injury at the …………. side

Answer 4

Same | opposite

Question 5

Types of brain lesions

Answer 5

Primary

Secondary

Question 6

Primary brain lesion

Answer 6

Caused by trauma
Skull fracture
Extra axial hemorrhage
Intra axial lesions (DAI, Contusions IVH)

Question 7

Secondary brain lesions

Answer 7

Arise from :
Brain’s response to trauma
Compression on the structures
(Brain, CN, BV, skull, dura)

Herniations, diffused edema, infarction

Question 8

In TBI, which type of imaging do you use

Answer 8

Non-contrast axial scan
3mm slice thickness
Bone algorithm
Coronal and Sagittal reformation

Question 9

CT imaging protocol

Answer 9

Maxillary hemosinus > Facial CT

Basilar skull fracture > CT angio and skull base reformation

Suspect C-spine fracture > C-spine CT

Question 10

Layers of the skull

Answer 10

Outer table
Dipole
Inner table

Question 11

Part of the skull without ………….. are more ………….

Answer 11

Diploe | weak

Question 12

Part of the skull without diploe

Answer 12

Squamous temporal
Squamous partial
Foramen magnum
Skull base
Cribiform plates
Orbital roofs

Question 13

Types of skull fractures

Answer 13

Linear fracture (EDH, SDH)

Depressed fracture (Focal parenchymal lesions)

Skull base fracture

Open head injury (Laceration of dura)

Question 14

…………… skull x-ray does not mean …………

Answer 14

Negative | No CT

Question 15

Causes of diffuse axonal injury (DAI)

Answer 15

Traumatic acceleration/deceleration

Violent rotation

Question 16

Cerebral contusions result from

Answer 16

Impact of gyri to the inner table of skull

Question 17

Intraparenchymal hematoma result from

Answer 17

Parenchymal vessel rupture from blunt or penetrating forces

Question 18

Intraventricular hemorrhage :

Answer 18

Uncommon
Result from severe trauma
a/w DAI and trauma of deep grey and brainstem
Poor prognosis

Question 19

Extra dural hemorrhage

Answer 19

Acute presentation
Associated with skull fracture
Unilateral
Biconvex
Does not cross sutures
More in pts <40 years old

Question 20

Subdural hematoma

Answer 20

Acute to subacute to chronic presentation
All ages
May be bilateral
No association with fracture
Usually due to trauma

Question 21

Traumatic subarchnoid hemorrhage (TSAH)

Answer 21

Usually associated with other injuries

Common with contusions

Question 22

Herniation is a ………… lesion

Answer 22

Secondary

Question 23

Herniation types

Answer 23

Uncal
Central
Cingulate (subfalcine)
Transcalvarial 
Upward
Tonsillar

Question 24

Most common type of brain herniations is

Answer 24

Subfalcine (cingulate)

Question 25

Characters of posttraumatic traumatic cerebral edema

Answer 25

Generalized obliteration of cortical sulci and SA spaces Thin ventricles Diffused hypodensity Loss of grey-white matter interface

Question 26

Posttraumatic ischemia/infarct m/c cause

Answer 26

Herniation

Question 27

m/c location of posttraumatic ischemia/infarct

Answer 27

Occipital (PCA)

Question 28

2nd m/c location of posttraumatic ischemia/infarct

Answer 28

Frontal (ACA)

Question 29

Rare location of posttraumatic ischemia/infarct

Answer 29

Basal ganglia

Question 30

Posttraumatic secondary hemorrhage

Answer 30

Small hemorrhage Classic in midline of pontomesencephalic junction May be multiple May extend to cerebellar peduncles

Question 31

Acute hydrocephalus can occur secondary to

Answer 31

Brain herniation | IVH

Question 32

Delayed hydrocephalus usually secondary to

Answer 32

``` Adherence of meninges to Cerebral convexity Basal cisterna Aqueduct Resulting in obstruction at level of ventricles and arachnoid granulations ```

Question 33

Pros of MRI in TBI

Answer 33

Sensitive to small injuries | Better differentiation of hemorrhagic and non hemorrhagic lesion