Trauma craneano gsb
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Evaluación radiológica del trauma craneoencefálico
Dr. Gerardo Sela Bayardo.
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Density, is the name of the gameRX TAC US RM
T1RMT2
LIQUIDO DPB HIPODENSO0 a 10 uh
ANECOICO HIPO INTENSO HIPERI NTENS
CALCIO, MCMETAL
MUYRX OPACO
HIPER HIPER CONSOMBRA
HIPO HIPO
AIRE RXLUCIDO
HIPO- 1000
HIPER CONSOMBRA
HIPO HIPO
GRASA POCO RXLUCIDA
HIPO- 150
HIPER SINSOMBRA
HIPER HIPO
VISCERAS DPB DPB40 a 50 UH
EGOCINTERMED
HIPO HIPO
SANGRE DPB HIPER60 UH
HIPERHPO
Depende de la etapa: Hiperaguda, aguda, subaguda y cronica. QRS
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Caracterizacion
1. Densidad
2. Tamaño
3. Localización
4. Numero
5. Comportamiento
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LOCALIZACION• Intraxial
• Extraxial
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Localización
• Supra vs. infratentorial
• Intra vs. extra axial
• Superficial o profunda
• Localizaciones especiales
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Supra o infra tentorial
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Superficial o profunda
• Profundas• linfoma
• glioblastomas
• Superficiales• Cisticercos
• Hamartomas
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Localizaciones especiales
• Subependimario
• Región selar
• Ala mayor esfenoides
• Linea media • 3er. Ventrículo
• Cordomas
• Quiste coloide
• etc
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Numero
• Única
• Múltiple• Metástasis
• Hemorragias
• Linfoma
• Parasitarias
• Etc.
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Densidad
• Hiperdensas• Hipodensas• Isodensas• Heterogéneas
• Intensas
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Características
1. Calcificaciones
2. Hemorragia
3. Edema (LIMA) Linfoma
Infarto
Metastasis
Absceso
4. Necrosis
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Comportamiento
1. Reforzamiento1. Ausente (Aplicación?)
2. Presente 1. Anillo
2. Homogéneo
3. Heterogéneo
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Comportamiento
Patrón
• Alas de mariposa• Astrocitomas
• Subependimario• Hemorragias
• Linfomas
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Contornos
• Nítido
• Difuso
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Reforzamiento
• Anular• Absceso
• Metastasis
• Tumor quistico
• Acentuado
• Escaso
• Homogéneo
• Heterogéneo
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Localizaciones características
• Uni o bilateral
• Alas de mariposa
• Subependimaria
• Tercer ventrículo
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Asociada a otros hallazgos
• Calcificaciones
• Edema
• Hemorragia
• Necrosis
• Quisticas.
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Efecto de masa
• El edema agregado puede producir sintomatología no inherente a la lesión misma.
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TCE
• Lesiones primarias.• Lesión axonal difusa
• Contusiones
• Hemorragias
• Fractura de cráneo
• Lesiones secundarias• Herniación cerebral
• Isquemia
• Edema
• Hemorragia tardía
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Tomografía
Ventajas• Efecto de masa.
• Tamaño y forma de los ventrículos.
• Lesión osea
• Hemorragia
• Rápido
Limitaciones
• No se valora lesiones pequeñas.
• No se puede ver lesión axonaldifusa, edema, hipoxia.
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Resonancia magnetica.
Ventajas
• Mejor en hemorragia subdural, encefalopatiaanoxoisquemica, lesion axonal difusa.
• Lesiones a largo plazo.
• Cuando CT no resuelve.
Desventajas
• No disponible siempre.
• Incompatible con dispositivos medicos.
• Insensible para hemorragia subaracnoidea.
• Costo
T1 FLAIR T2 DIFUSION
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Rx de craneo
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Signos Rx cráneo hipertensivo
1. > impresiones digitiformes.
2. Diastasis de suturas
3. Erosión de la silla.
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Fracturas
26
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emj.bmj.com
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Fractura de craneo
http://surgery.arizona.edu/sites/surgery.arizona.edu/files/images/Fig1_skull-fracture.jpg
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1. Hematoma subcutáneo
2. Hematoma subgaleal
3. Subperiostico (cefalohematoma)
4. Epidural
5. Subdural
6. Subaracnoideo
7. Parenquimatoso
8. Subependimario
9. Intraventricular
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Density, is the name of the gameRX TAC US RM
T1RMT2
LIQUIDO DPB HIPODENSO0 a 10 uh
ANECOICO HIPO INTENSO HIPERI NTENS
CALCIO, MCMETAL
MUYRX OPACO
HIPER HIPER CONSOMBRA
HIPO HIPO
AIRE RXLUCIDO
HIPO- 1000
HIPER CONSOMBRA
HIPO HIPO
GRASA POCO RXLUCIDA
HIPO- 150
HIPER SINSOMBRA
HIPER HIPO
VISCERAS DPB DPB40 a 50 UH
EGOCINTERMED
HIPO HIPO
SANGRE DPB HIPER60 UH
HIPERHPO
Depende de la etapa: Hiperaguda, aguda, subaguda y cronica. QRS
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Evolución de hemorragia
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Lesion axonal difusa
http://images.radiopaedia.org/images/18727/260815b66b7b3afc480a7a17cd6206.jpg
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Edema cerebral difuso
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Hernias cerebrales
1. Hernia subfalcina (sobre todo tumores frontales),
2. Transtentorial de abajo a arriba y la amígdalas (tumores cerebelosos).
3. Hernia uncal (tumores del lóbulo temporal),
4. De Amígdalas
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La herniación subfalcina• (sobre todo tumores frontales)
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herniación uncus
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transtentorial
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Amígdalas
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Ictus
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Masculino 27 a. hemiparesia izquierda. Herido por arma de fuego en area precordial
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Isquemia post traumática, infarto.
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