How To Read Brain CT Scan

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How to Read
Brain CT Scan
dr,. Elric B. Malelak, Sp.BS
Department of Neurosurgery, Prof Dr. W.Z. Johannes

Regional General Hospital, Kupang, East Nusa Tenggara, Indonesia
z Basic Principles of CT Scan
 Invented by Sir Godrey Hounsfield
 Uses X rays applied in sequence of

slices across the organ
 Images reconstructed from X ray

absorption data
 X ray beam moves around the

patient in a circular path
z
 CT Scan provide a 3D display of

the intracranial anatomy built up
from a cervical series of
transverse axial tomograms
 Each tomogram represents a

horizontal slice through the
patients head
 Slice thickness may vary, but in

general,it is between 5 dan10mm
for a routine head CT
 Always describe CT findings as densities:
isodense/hypodense/hyperdense
 Higher the density = white is appearance
 Lower the density = darker the appearance
 Brain is the reference density
 Anything of the density as brain = isodense
 Higher density than brain= hyperdense (skull is the best example)
 Anything darker (lower density) than brain= hypodense (CSF and air are
classical example)
z
Hounsfield Unit
z Densities of CT Scan
z
Normal Neuroanatomy As Seen on

Head CT Scans
z Axial sections of CT Head
 Posterior Fossa Cuts

 Above the Foramen Magnum Level
 Level of the Fourth Ventricle
 Above the Fourth Ventricular Level
 Tentorial
 Supratentorial Cuts
 Third Ventricular Level
 Lateral Ventricular Level
 Above the Ventricular Level
z Normal Anatomy
z Normal Anatomy
z Normal Anatomy
z Normal Anatomy
z Normal Anatomy
z Normal Anatomy
z Normal Anatomy
z Normal Anatomy
z
z
z
z Physioloical Calcifications
z
Traumatic brain injury on CT Scan

Traumatic
z Brain Injury (TBI)
 Leading cause of death and disability
 Mortality related to Glasglow Coma Scale (GCS)

Closed or Open TBI ?
z
z Primary or Secondary TBI ?
z
z
Skull Fracture
z Quick Anatomy
 3 layers
 Outer table
 Diploe
 Inner table
 Parts without diploe prone to fracture

 Squamous temporal / parietal bone
 Foramen magnum, skull bases, cribiform plates, orbital roof
z Types Of Skull Fractures
 Linear fracture (with/without subdural hematoma / epidural hematoma)
 Depressed Fracture
 Skull Base Fracture
 Open Head Injuries

 Knife, firearm
 Laceration of dura
z Depressed Skull Fracture
 Criteria to Elevate:
 >= 8-10 mm depression
 Deficit related to underlying brain
 CSF leak
z
Intracranial Haemorrhage (ICH)

z Intracranial Haemorrhage (ICH)
 Parenchymal vessel rupture from

blunt or penetrating forces
 May not lose consciousness
 Hematoma at primary trauma site

(usually frontal and temporal)
z Intracranial Haemorrhage (ICH)
 Well-circumscribed hyperdense
lesion w/wo perilesional edema
 With / without SDH, EDH, IVH
 Hematoma at primary trauma site

(usually frontal and temporal)
z
Epidural Hematoma (EDH)

z Epidural Hematoma (EDH)
 Hematoma between inner table

of the skull and dura
 Most common sourve of bleeding

= middle meningeal artery
 Most urgent of all cases of cranial

trauma
 Lucid interval may present

Epidural
z Hematoma (EDH)
 Biconvex or lens shape

hyperdense lesion
 May cross midline and dural

attachment
 Do not cross suture (except

diastatic fracture, large EDH)
z Swirl Sign
Small rounded lesion

isodense to the brain,
representing active
extravasation of unclotted
blood
z
Subdural Hematoma (SDH)

z Subdural Hematoma (SDH)
 Blood collects between dura

and arachnoid
 Torn bridging veins

z Subdural Hematoma (SDH)
 Usually co-exist with other

brain injuries
 Crescentic hyperdense
collection
 Can cross suture

Isodense subdural Hematoma
z
 Subacute SDH
 Anemic patients can

present with acute
isodense SDH
z Acute on Chronic SDH
 New Hemorrhage superimposed

on chronic SDH
 Recurrent trauma
 Can be spontaneous
 Blood-fluid level, blood clot

organization, membranes
z Comparison of EDH and SDH
z
z Bibliography
 Mark S Greenberg. Handbook of Neurosurgery. 2020. Thieme Medical Publishers.

Inc
 William E. Brant. Fundamentals of diagnostic Radiology. 2012. Lippincott Williams &

Wilkins
 Kumar et al, Basic Pathology 7E

How To Read Brain CT Scan

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How To Read Brain CT Scan

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z

Department of Neurosurgery, Prof Dr. W.Z. Johannes

 Invented by Sir Godrey Hounsfield

 Uses X rays applied in sequence of

 Images reconstructed from X ray

 X ray beam moves around the

 CT Scan provide a 3D display of

 Each tomogram represents a

 Slice thickness may vary, but in

 Higher the density = white is appearance

 Lower the density = darker the appearance

 Brain is the reference density

 Anything of the density as brain = isodense

 Higher density than brain= hyperdense (skull is the best example)

Normal Neuroanatomy As Seen on

 Posterior Fossa Cuts

Traumatic brain injury on CT Scan

 Leading cause of death and disability

 Mortality related to Glasglow Coma Scale (GCS)

 Parts without diploe prone to fracture

 Linear fracture (with/without subdural hematoma / epidural hematoma)

 Skull Base Fracture

 Open Head Injuries

 >= 8-10 mm depression

 Deficit related to underlying brain

Intracranial Haemorrhage (ICH)

 Parenchymal vessel rupture from

 May not lose consciousness

 Hematoma at primary trauma site

 With / without SDH, EDH, IVH

 Hematoma at primary trauma site

Epidural Hematoma (EDH)

 Hematoma between inner table

 Most common sourve of bleeding

 Most urgent of all cases of cranial

 Lucid interval may present

 Biconvex or lens shape

 May cross midline and dural

 Do not cross suture (except

Small rounded lesion

Subdural Hematoma (SDH)

 Blood collects between dura

 Torn bridging veins

 Usually co-exist with other

 Can cross suture

 Anemic patients can

 New Hemorrhage superimposed

 Blood-fluid level, blood clot

 Mark S Greenberg. Handbook of Neurosurgery. 2020. Thieme Medical Publishers.

 William E. Brant. Fundamentals of diagnostic Radiology. 2012. Lippincott Williams &

 Kumar et al, Basic Pathology 7E

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