<\/p>\n
Mnemonic:\u00a0 Blood Can Be Very Bad (1)<\/strong><\/p>\n B<\/p>\n lood:<\/p>\n <\/p>\n EDH (Lens Shaped) SDH (Sickle Shaped, Consider subdural window) Intraparenchymal Blood (Especially in the Basal Ganglia) Intraventricular Blood (Look for hydrocephalus) SAH (Blood in Cisterns and Fissures)<\/strong><\/p>\n C<\/p>\n isterns:<\/p>\n <\/p>\n Look for effacement and blood Circummesencephalic (Ring around the midbrain) Suprasellar (Star shaped at Circle of Willis) Quadrigeminal (W shaped) Sylvian (Between temporal and frontal lobes)<\/p>\n B<\/p>\n rain:<\/p>\n <\/p>\n Symmetry Gray\/White Matter differentiation (Insular Ribbon) Shift Hyper\/Hypodensities Pneumocephalus<\/p>\n V<\/p>\n entricles:<\/p>\n <\/p>\n Effacement Shift Hydrocephalus (Examine sulci to differentiate between hydro and atrophy) Blood<\/p>\n B<\/p>\n one:<\/p>\n <\/p>\n Skull fractures, especially basilar (Consider bone windows) Sinuses and Air cells (Look for Air\/Fluid levels)<\/p>\n 1.\u00a0 Perron, AD, et al:\u00a0 A Multicenter Study to Improve Emergency Medicine Residents\u0092 Recognition of Intracranial Emergencies on Computed Tomography.\u00a0 Ann Emerg Med<\/em> 1998;32:5, 554-562.<\/p>\n 2.\u00a0 Ouellette, H, et al:\u00a0 Clinical Radiology made ridiculously simple<\/em>.\u00a0 Medmaster.\u00a0 Miami, Florida:\u00a0 2000.<\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n a) Subfalcial (cingulate) herniation ; b) uncal herniation ; c) downward (central, transtentorial) herniation ; d) external herniation ; e) tonsillar herniation. Types a, b, & e are usually caused by focal, ipsilateral space occupying lesions, ie., tumor or axial or extra-axial hemorrhage<\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n mediastinal windows (level 39, width 500)<\/strong><\/p>\n lung windows (level 2775, width 850)<\/strong><\/p>\n Head <\/strong>Level 40 Width 90<\/p>\n <\/p>\n <\/p>\n CSF made first in ventricles then flows through aqueduct of sylvius then through foramen lushkun then into the cisterns surrounding the outside of the brain<\/p>\n cisterns are the first thing to squish with edema and elevated ICP<\/p>\n <\/p>\n three key cuts pons\/suprasellar\/midbrain<\/p>\n <\/p>\n base of skull:<\/p>\n sphenoids up front they look like McDonald’s arches which culminate in anterior clinoids in suprasellar cistern<\/p>\n <\/p>\n petrosal bones behind suprasellar a transverse crack can jeopardize 7th or 8th cranial nerve. CSF leak also problematic if dural tear<\/p>\n <\/p>\n sphenoid sinus just in fron of suprasellar on base of skull cut<\/p>\n <\/p>\n beam hardening artifact in cerebellum do to surrounding bone<\/p>\n <\/p>\n can see blood in temporal tips<\/p>\n <\/p>\n Mastoid Air cells towards back<\/p>\n <\/p>\n ethmoid sinus on one cut up<\/p>\n <\/p>\n see 4th ventricle and cistern forward of it, this is the circummesencephalic because it is around the midbrain=signet ring<\/p>\n <\/p>\n 4th ventricle is darth vaders helmut<\/p>\n <\/p>\n Suprasellar cistern is the 2nd key cut<\/p>\n <\/p>\n the star mans arms reach for the sylvian cisterns<\/p>\n legs dangle down over the midbrain<\/p>\n <\/p>\n can see clinoids sticking up into starman<\/p>\n <\/p>\n <\/p>\n high midbrain<\/p>\n quadrigeminal cistern: w shaped right behind quadrigeminal plate where optic nerve runs<\/p>\n first cistern to get compressed<\/p>\n cerebellar folds also disappear c inreased icp<\/p>\n <\/p>\n location of venous blood<\/p>\n rostral cerebellar vermis just behind quad cistern, they become prominent in etoh folks<\/p>\n sylvian fissures separate frontal and temporal lobes<\/p>\n <\/p>\n <\/p>\n TEMPORAL TIPS BLOW UP FIRST IN HYDROCEPHALUS, on same cut as suprasellar<\/p>\n <\/p>\n Sulcal pattern disappears with tight brain<\/p>\n Circummesencephalic disappears<\/p>\n <\/p>\n tentorium blood layers out in SAH<\/p>\n <\/p>\n falx is what you look at for shift<\/p>\n <\/p>\n subdurals can layer out over tentorium<\/p>\n falx subdurals can be confused c calcified falx<\/p>\n <\/p>\n intraparenchymal bleeds can rupture into the ventricles, then they get hydrocephalus<\/p>\n calcified pineal gland at same level as occipital horns<\/p>\n day 3 is the worst day for bleeds blossoming<\/p>\n <\/p>\n grey\/white differentiation is early stroke, grey (which looks white on ct) takes on water and starts to look grey (which is how white matter looks)<\/p>\n <\/p>\n acute hydrocephalus can gives trans-ependymal flow (exudes into brain tissue) dark around lateral ventricles, periventricular white matter disease can look similar<\/p>\n <\/p>\n <\/p>\n look at petrous bone for basilar skull fxs<\/p>\n <\/p>\n no gross blood, cisterns are black and open, brain is symmetric with normal density, the skull and sinuses are normal, there is no evidence of hydrocephalus, no emergent dx noted on CT scan<\/p>\n <\/p>\n 1 in 5 get acute hydrocephalus from SAH<\/p>\n <\/p>\n Suprasellar cistern is effaced then ipsilateral cerbellopontine angle is enlarged till progressive obliteration of suprasellar cistern and basilar cisterns<\/p>\n <\/p>\n <\/p>\n Look for it in the midbrain at the level of the star<\/p>\n Describe it as open (all three limbs open), partially closed (one or two limbs obliterated), or completely closed<\/p>\n <\/p>\n Measure for midline shift at the foramen of monro.<\/p>\n![\"\"](\"\/wp-content\/images\/part1\/1-X.opt.jpg\")
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