Questions
Is blood present?
If so, where is it?
If so, what effect is it having?
Physiology
Acute blood is bright white (once it clots)
Blood becomes isodense at 1wk (exact time depends on size of clot)
Blood becomes hypodense at 2wks (exact time depends on size of clot)
Findings
Epidural hematoma (blood problem)
Lens shaped
Does not cross sutures
Classically described with injury to middle meningeal artery
Low mortality if treated prior to unconsciousness (<20% morbidity/mortality)
Subdural (brain problem)
Sickle shaped
Crosses sutures but not midline
Marker for severe head injury (mortality approaches 80%)
Small amount of bleed can be associated with major shift (secondary to brain injury/oozing)
SAH
Blood in the cisterns/cortical gyral surface/interhemispheric fissure
Suprasellar cistern is first place see SAH (location adjacent to circle of willis)
Aneurysm: 80%
AVM: 5%
Intraventricular/Intraparenchymal Hemorrhage
Typically obvious findings
Unimportant if intraventricular ruptured into parenchyma or vice-versa
Is blood present?
If so, where is it?
If so, what effect is it having?
Acute blood is bright white (once it clots)
Blood becomes isodense at 1wk (exact time depends on size of clot)
Blood becomes hypodense at 2wks (exact time depends on size of clot)
Epidural hematoma (blood problem)
Lens shaped
Does not cross sutures
Classically described with injury to middle meningeal artery
Low mortality if treated prior to unconsciousness (<20% morbidity/mortality)
Subdural (brain problem)
Sickle shaped
Crosses sutures but not midline
Marker for severe head injury (mortality approaches 80%)
Small amount of bleed can be associated with major shift (secondary to brain injury/oozing)
SAH
Blood in the cisterns/cortical gyral surface/interhemispheric fissure
Suprasellar cistern is first place see SAH (location adjacent to circle of willis)
Aneurysm: 80%
AVM: 5%
Intraventricular/Intraparenchymal Hemorrhage
Typically obvious findings
Unimportant if intraventricular ruptured into parenchyma or vice-versa
Lens shaped
Does not cross sutures
Classically described with injury to middle meningeal artery
Low mortality if treated prior to unconsciousness (<20% morbidity/mortality)
Sickle shaped
Crosses sutures but not midline
Marker for severe head injury (mortality approaches 80%)
Small amount of bleed can be associated with major shift (secondary to brain injury/oozing)
Small amount of bleed can be associated with major shift (secondary to brain injury/oozing)
Blood in the cisterns/cortical gyral surface/interhemispheric fissure
Suprasellar cistern is first place see SAH (location adjacent to circle of willis)
Aneurysm: 80%
AVM: 5%
Suprasellar cistern is first place see SAH (location adjacent to circle of willis)
Typically obvious findings
Unimportant if intraventricular ruptured into parenchyma or vice-versa
CT brain interpretation
Brain MRI
NIH Stroke Scale
Glasgow Coma Scale
Cardiac ultrasound
Prehospital protocol pediatric seizure
Lumbar puncture
Mini mental status exam