Jy gauvrit imaging after traumatic brain injury jfim hanoi 2015
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Transcript of Jy gauvrit imaging after traumatic brain injury jfim hanoi 2015
Imaginga(ertrauma-cbraininjury
JYGauvrit,LRiffaudRadiology&Neurosurgerydepartment,Rennes
Hanoi,Nov2015
Trauma-cBrainInjury(TBI)inFrance
• 200000TBI/year
• 12000deaths/year
• 5‰among15-25year-olds
• 50%deathsamong<25-year-olds
• Causesasmanydisabili-esasstroke
Objec-ves
• Understandingtheindica-onsforcerebralimaginga(ercranio-encephalictrauma
• Understandingtheprimarylesionsandsecondarycomplica-onsofcranio-encephalictrauma
• Understandingpost-trauma-cvascularlesions• Facialfracturesandcomplica-ons
InjurymechanismsScalp
Bone
Meninges
Brain
Wounds
Fractures,Depressedskullfractures
ExtraduralhematomasSubduralhematomas
Hemorrhages
ContusionsEdema
SkullFracture
• CT• Tellsastory• Uptoskullvertex• Bones– Laminaexterna(externaltable)– Diploë– Laminainterna(internaltable)
SkullFracture
openskullfracture=sepsisrisk=surgeryinemergency
Surgicalemergency=Majordisplacement-hernia-on-skinopening
Epidural-extraduralhematoma• Betweenthelaminainternaandduramater• Arterial(mayinvolvesinusbutnotbonesuturelines)• Venous(lacera-onofdiploicveinsandduralsinus)Middlecranialfossa• TBIwithlossofconsciousness• Lucidinterval• Secondaryclinicalsigns
• Riskfactors:youngage,directimpactonfragileareas(temporalandoccipital)BenignAnteriorTemporalEpiduralHematoma:IndolentLesionwithaCharacteris<cCTImagingAppearancea=erBluntHeadTrauma
AlisaD.Gean,MD,,NancyJ.Fischbein,MD,,DerkD.Purcell,MD,,AshleyH.Aiken,MD,GeoffreyT.Manley,MD,PhD,andShirleyI.S<ver,MD,PhD,
Epidural-extraduralhematoma
CT=Biconvexhyperdense"lens"
monstrous bilateral plane
minimal Infra-tentorial supra-tentorial
Subduralhematoma
• Betweencerebralconvexityandinnersurfaceoftheduramater
• Veintearordetachmentfromthebrainsurface(concussion)
Cor-coduralveinstornbridgingfromtheirfixedpointsoutintothesubduralspace
Subduralhematoma
• Involvesthebonesuturelinesbutnotthesinuses
• Acutesubduralhematoma(SDH)displayshighestmortalityrateofallheadinjuries
Subduralhematoma
Acuteinter-hemisphericsubduralhematoma
Extremelylargeacutesubduralhematomawithsignificantmasseffect
EDH SDH
Loca-on Facingthetraumaimpact Directimpactordecelera-on/accelera-on
Shape Biconvexhyperdense"lens" Hyperdensecrescentblade
Extension Involvesthefalxcerebriandtentoriumbutnotthesuturelines
Crossesthesuturelinesbutnotthetentoriumorfalx
Origin 90%arterial 90%venous
Side Unilateral Unilateralorbilateral
Associatedinjury 90%:cranialvaultfractures 70%:intra-axialinjury(contusions)
Evolu-onin-me Lucidintervalsin50%ofcases Immediatelypresent
Other Swirledappearance=ac-vebleedingIfpresenceofair:mastoidorsinusfracture
Inchildren:suspicionofabuse
Epidural/subduralhematoma
Subarachnoidhemorrhage
• O(en"counter-blow"injurya(erdirectimpact• Associatedwithparenchymalcontusions
Cerebralcontusions• "Blow"
• "Counter-blow"++
• Intypicalareaswherethebrainbouncesagainstaduralridgeorbonyprotrusion:– Temporallobes– Inferiorsurfaceoffrontallobes– Lateralsulcus
Occipitallobeinjury
• O(enseveretrauma• Cranialimpactunprotected
byhandsorface• Bifrontalcerebral"counter-
blow"injury(cogni-vedysfunc-on+++anosmia)
• Risktobrainstemduetoshockwave
Cerebralcontusions
Diffuseaxonalinjury
• Kine-c• Decelera-on-accelera-on– Shearing
• Grayandwhitemakerjunc-on– Cor-cal-subcor-cal– Basalganglia– Mesencephalic
• SevereprognosisParizelPMetalEurRadiol2005;15:589-81NakayamaN,etalJneurolneurosurgPsychiatry2006;77:850-55
Diffuseaxonalinjury
• CTscanunderes-matesso….MRI• PerformMRIeach-methescanresultsandneurologicalworkup(GCS)areconflic-ng
• Diffusion:acute• SWI:subacute,chronic
• CorpuscallosumParizelPMetalEurRadiol2005;15:589-81NakayamaN,etalJneurolneurosurgPsychiatry2006;77:850-55
Hernia-on
• Supratentorialhernia-ons1. Cingulate(subfalcial)2. Central3. Uncal(innersidetemporallobe)4. Transcalvarial
• Infratentorialhernia-ons5. Transtentorial:superiorcerebellumvermis5. Tonsillar
Hernia-on
• Transtentorialhernia-ons– Subarachnoidperimesencephalicspaces
• Visible:safe• Effaced:danger
Dissec-on
Denvercriteria• Cervicalspine
fracture• Centralneurologic
deficit,unexplainedwithCT
• CBHsyndrome• Naso-orbito-Ethmoid
fractures• Skull-baseFracture• Expandingneck
hematoma
WhattoRemember?• Thebump• Thefracturetellsastory• EDH=mainlyarterial,butsome-mesvenous• Uptoskullvertex• ChronicSDH=highestmortalityrateofallencephalicinjuries
• "Blow"and"counter-blow"injuries• MRIwhenclinical(GCS)andCTdisagree• Subarachnoidperimesencephalicspaces• Secondarycomplica-ons=unfavorableprognosis• Anyheadtraumarepresentspoten-altraumatothespine