Intra Cranial Hematoma
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Transcript of Intra Cranial Hematoma
![Page 1: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/1.jpg)
Imaging in head injury
![Page 2: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/2.jpg)
X-ray
• Detect skull fractures
• Include neck in coma
• Role is limited
![Page 3: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/3.jpg)
CT scan
• Rapid
• Non invasive
• Bony & soft tissue injury
• Site
![Page 4: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/4.jpg)
CT
• Nature
• Midline shifts
• Mass effect
• Presence of FB & air
![Page 5: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/5.jpg)
Disadvantages
• Vascular lesions missed
• Artefacts
• Vertex fractures missed
• Motion can degrade images
![Page 6: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/6.jpg)
Indications
• Coma
• No improvement
• Falling GCS
• Depressed skull fractures
• Post traumatic seizures
![Page 7: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/7.jpg)
Indications for serial CT
• Resolution of small hematomas
• Delayed hematomas
• Post traumatic changes
• Immediate post operative - baseline
![Page 8: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/8.jpg)
MRI
• Vascular lesions – aneurysm, ccf
• Brain stem injuries
• Axonal injuries
• Contusions, small hematomas
![Page 9: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/9.jpg)
Disadvantages
• Expensive
• Longer imaging time
• Fractures not well seen
• SAH not well seen
![Page 10: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/10.jpg)
Others
• EEG- seizure focus, brain death
• Ventriculography – CSF loculation ,cysts
• Angiography – vascular lesions
![Page 11: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/11.jpg)
Indications of CT in head injury
• Skull fracture with
confusion & altered LOC
FND
seizures
![Page 12: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/12.jpg)
Indications of CT in head injury
• Without skull fracture
persistent confusion
impaired LOC after resuscitation
![Page 13: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/13.jpg)
Indications of CT in head injury
• Deteriorisation of LOC
• Depressed skull fractures
• Penetrating / open skull fractures
• Uncertain diagnosis
• Tense frontanelle
![Page 14: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/14.jpg)
Intra cranial hematoma
![Page 15: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/15.jpg)
Acute SDH
![Page 16: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/16.jpg)
Source
• Parasagittal bridging veins
• They drain the surface to dural sinuses
• Associated paranchymal injury
![Page 17: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/17.jpg)
SDH
• Level of consciousness
• Anisocoria
• Motor deficit
![Page 18: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/18.jpg)
Anisocoria
• Ipsilateral to pupillary dialatation
• Opposite to motor deficit
![Page 19: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/19.jpg)
SDH
• A/C
• Sub a/c
• c/c
![Page 20: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/20.jpg)
A/C
• 2-3 days
• Hyperdense in CT
• c/f resemble a/c EDH
• Common in young
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CT
• Crescendic
• Laculnar
• concavoconvex
![Page 22: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/22.jpg)
Treatment
• Conservative
• Surgical
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conservative
• Size 4mm shift, 8mm size
• Site – temporal tip
• GCS
![Page 24: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/24.jpg)
Surgery
• Craniotomy
• evacuation
![Page 25: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/25.jpg)
Sub a/c
• 2-3 wks
• Isodense
• MRI
![Page 26: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/26.jpg)
C/C
• Similar to mass lesion
• Old age
• May not remember injury
![Page 27: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/27.jpg)
• Less symptoms
• Large lesion
• Brain atrophy
![Page 28: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/28.jpg)
Investigation
• CT
• Hypodense lesion
![Page 29: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/29.jpg)
Treatment
• Conservative
• Surgery
![Page 30: Intra Cranial Hematoma](https://reader035.fdocuments.us/reader035/viewer/2022062419/558654c0d8b42a007f8b4784/html5/thumbnails/30.jpg)
Surgery
• Craniotomy
• Burr hole