Erin O’Connor

NEURORADIOLOGY TRAUMA WORKSHOP

LEARNING OBJECTIVES

• Know the appropriate imaging work up for patients with head trauma.

• Recognize the appearance of intracranial hemorrhage on CT, specifically epidural, subdural, subarachnoid and intraparenchymal hemorrhage.

• Describe the various types and causes of brain herniation.

• Recognize the typical changes in appearance of intracranial blood products with age on CT

• See the typical appearance of diffuse axonal injury on MRI and CT

• List criteria that are used in spinal trauma to determine if the patient should have CT of the cervical spine.

• Describe some of the traumatic injuries than can be seen on a lateral c-spine radiograph

TRAUMA TO THE HEAD

• What imaging modality would you use?

• What are you looking for?

• Why not use MRI is setting acute trauma to head?

BRAIN CONTUSIONS

• What are they?

• Where do they typically occur?

Figure 9.  Acute trauma in a 17-year-old pregnant girl after a rollover motor vehicle accident in which she lost consciousness.

Goldman S M , Wagner L K Radiographics 1999;19:1349-1357

©1999 by Radiological Society of North America

DIFFUSE AXONAL INJURY

• What is it? How do patients get it?

• Describe the clinical picture of DAI?

• Where does it occur?

• What is the best way to detect it on imaging?

TRAUMA TO THE NECK

• What imaging modality would you use?

• What are you looking for?

NORMAL CT CERVICAL SPINE

NORMAL CT CERVICAL SPINE

NORMAL CT CERVICAL SPINE

• Medrol 32 mg po (or its equivalent) 12 and 2 hours prior to contrast administration.

• Some also give benadryl at time of contrast adminstration

• Cardiac pacemakers, insulin pumps, neurostimulators, cochlear implants

• Non-graphite spinal cord tongs: Graphite tongs are compatible.

• Thermodilution Swan-Ganz catheter: Local heating can result.

• Metal outside the brain and eye is NOT a contraindication: Cardiac valves, inferior vena cava filters, biliary and vascular stents, IUD's and metallic prostheses are safe, unless doubt as to positional stability.

• Plain radiography sufficient for screening.

BUT WHAT IF…

CONTRAINDICATIONS TO MRIKNOWN ALLERGIES TO CONTRAST