Clinical question: Evidence of herniation, please evaluate for brainstem and foramina magnum. Signs and symptoms: Status post PEA arrest, nonresponsive. Nonenhanced CT of brain:Portable CT at bedside is performed. Images through posterior fossa are severely obscured due to extensive artifact from patient's multiple bilateral dental fillings. The brainstem cannot be properly evaluated due to extensive artifact. Recommend follow-up with a standard nonportable CT. The fourth ventricle is identified in the midline. The prior portable CT did not include the fourth ventricle and comparison cannot be made.Images through supratentorial space demonstrate no gross evidence of hemorrhage, mass-effect, hydrocephalus or midline shift. Possibility of edema cannot be evaluated due to very poor quality of the study. There is however no visualization of cortical sulci this may indicate underlying diffuse cerebral edema. Follow-up exam with a dedicated nonportable CT or an MRI is recommended.
Suboptimal study due to extensive artifact however no gross abnormality since prior exam. Possibility of cerebral edema cannot be evaluated.