HEAD CT SCAN

Dr. Risda Fitriyani

ANATOMY

VASCULAR
SUPPLY

Ekspertise CT scan kepala normal

(yang dinilai pada CT scan kepala)
Tak tampak lesi hipodens maupun hiperdens pada
intrakranial
Differensiasi substantia alba dan grisea tampak normal
Sulkus kortikalis dan fissura sylvii kanan kiri normal
Ventrikel lateralis kanan kiri, III dan IV tampak normal
Cisterna perimescecephalic tampak normal
Tak tampak midline shifting
Pons dan cerebellum tampak normal
KESAN :

TAK TAMPAK INFARK, PERDARAHAN MAUPUN SOL PADA

INTRAKRANIAL
TAK TAMPAK TANDA-TANDA PENINGKATAN TEKANAN INTRAKRANIAL

CT CROSS-SECTIONAL ANATOMY

 Cerebral hemispher separated by falk cerebri & interhemispheric fissure

Gray matter appears lighter : white matter
Centrum semiovale = hemispheric subcortical white matter

The slice shows the bodies of the lateral ventricles,

which appear as paired crescent-shaped CSF
spaces (twin bananas)

Head CT Artifacts

CT Coefficients of X-ray Attenuation in

Hounsfield Units

HEAD TRAUMA

FRACTURES

Linear fracture
Depressed fracture
Basilar skull fracture
Frontal sinus fracture
Pneumocephalus
Growing fracture

Linear fracture
Axial CT scan with
bone algorithm shows
multiple fractures of
the right frontal and
parietal bones
(arrows).

Depressed Fracture
A fragment is
considered depressed
when its outer table is
displaced below the
level of the inner table
of the skull

Pneumocephalus

Pneumocephalus. Collections of air

overlie the frontal lobes and extend
along the anterior interhemispheric fi
ssure (arrows).

Air loculi in the

extracerebral spaces
typically indicate traumatic
air entry resulting from
fracture of a paranasal
sinus or mastoid air cells
May be complicated by
CSF leakage, empyema,
meningitis, or brain
abscess

Hematomas

Cephalhematoma
Intracerebral hematoma (ICH)
Epidural hematoma (EDH)
Subdural hematoma (SDH)
Subarachnoid hemorrhage (SAH)
Contusion
Diffuse axonal injury
Brain stem injury
Brain swelling & edema
Penetrating injury
Vascular injury

Intracerebral Hematoma
Homogeneously
hyperdense
Sharply marginated lesions
surrounded by a rim of
decreased density
Mass effect may be present
>> sites : frontal and
temporal lobes, basal
ganglia, posterior fossa
>> associated w/ other
traumatic lesions, ex : SAH,
SDH, IVH
Intraparenchymal hematoma. Large,
well-marginated intraparenchymal
hematoma in the right parietal lobe with
rupture into the ventricular system.

Epidural Hematoma

Damage to the middle meningeal artery

Biconvex or lentiform shape
>> Fracture of the adjacent bone (+)
Location : temporal lobe (>>). Parietal, frontal, occipital, posterior fossa
The shape is determined by the dura Perdarahan tidak melewati sutura

Subdural Hematoma
Tear the bridging veins
The degree of mass effect seen with an
SDH is often disproportionate to the size
of the SDH
Hyperdense Crescent-shaped collection
with a convex lateral border and concave
medial border overlying the cerebral
convexity
Biconcavity can be seen particularly when
the SDH is large
Acute, subacute (2-4 weeks post trauma),
chronic (>4 weeks post trauma)

Subdural hematoma

Acute SDH

Subacute SDH

Chronic SDH

Perdarahan melewati garis sutura

Subarachnoid Hemorrhage
>> acutely injured patient & associated
w/ other lesions, ex : ICH
Damage to blood vessels on the piaarachnoid
hyperdensity representing acute
hemorrhage is visualized in the sulci
overlying the cerebral convexities,
within the sylvian fissures, basal
cisterns, & interhemispheric fissure

Subarachnoid Hemorrhage
SAH is present in the
interhemispheric and left
sylvian fi ssures, as well
as in the cortical sulci of
the left frontal and
temporal lobes.
Blood in the frontal lobe
sulci is responsible for the
zigzag appearance of
the subarachnoid
hemorrhage.

Hemorrhagic Contusion
Heterogeneous increased density
mixed with or surrounded by areas
of decreased or normal density
Mass effect (+/-)
Frontal lobe convexity and the
lateral temporal areas are the most
common sites
Area dengan atenuasi rendah bersifat fokal,
multifokal yang becampur dengan area-area
kecil berdensitas tinggi yang menggambarkan
suat perdarahan

Hemorrhagic Contusion

Hemorrhagic contusions with

surrounding edema are evident in the
inferior left frontal and anterior right
temporal lobe(arrowheads).

Axial CT scan demonstrates multiple

hemorrhagic contusions in the temporal
lobes. Note the small left occipital lobe
convexity subdural hematoma (arrow).

Brain swelling & edema

Cerebral edema may be
cytotoxic, interstitial, or
vasogenic in origin
CT findings consist of
compression of the
lateral and third
ventricles and
perimesencephalic
cistern

Grading Diffuse Axonal Injury

(from Marshall LF, et al 1991)

TERIMAKASIH