Topic Progress:

CT Brain

[az_accordion_section] [accordion title=”What are some of the common CT brain findings seen in patients with a traumatic brain injury?” id=”acc-1″]

Multiple intracranial lesions are often present including:

– cerebral contusions;

– traumatic subarachnoid, subdural and extradural haemorrhage;

– small punctate hyperdense lesions at the grey-white interface indicative of diffuse axonal injury;

– loss of grey-white diffrentiation if marked swelling.


Skull and facial fractures may also be seen. [/accordion] [/az_accordion_section] 

Have a look at Jake’s scan below.   What are the abnormalities? 

TBI CT video

[az_accordion_section] [accordion title=”CT report” id=”acc-1″]There are multifocal intracranial haemorrhages. 8 mm haematoma posteriorly in the right side of the corpus callosum. Haematoma in the septum pellucidum. Haematoma and layering blood elements in the right lateral ventricle and right occipital horn, with layering also in the left occipital horn. Extensive subarachnoid blood in the right sylvian fissure, and to a lesser extent in the left sylvian fissure. [/accordion] [/az_accordion_section]

Progress CT brains are typically undertaken in the first 24 hours of ICU admission (often as a result of patient deterioration/neurological change or post-procedure).   In patients with diffuse injuries ~15% will develop new lesions, and ~35% (range 25-45%) of cerebral contusions will increase in size with progression thought to typically occur 6-9 hours after injury.



When do you think an MRI brain is necessary? 

[az_accordion_section] [accordion title=”Answer” id=”acc-1″]In patients with a TBI, MRI is often used to evaluate for diffuse axonal injury (DAI), as the findings on CTB are quite subtle. MRI is frequently undertaken in patient’s whose clinical presentation is inconsistent with their CTB ie. persistent low GCS despite a CTB with relatively benign findings.[/accordion] [/az_accordion_section]


[az_accordion_section] [accordion title=”What are the common MRI brain findings seen in patients with a traumatic brain injury?” id=”acc-1″]

 Findings on MRI include multiple focal lesions located at the grey-white matter junction, in the corpus callosum and in the brainstem (severe DAI). [/accordion] [/az_accordion_section]


Jake underwent an MRI brain (and C – spine as unable to clinically clear).  Have a look at his MRI below.  What are the abnormalities?  


[az_accordion_section] [accordion title=”MRI Report” id=”acc-1″]There  is  a  ventricular  drain  with  its  tip  in  the  right  frontal  horn. Widespread  subarachnoid  and  intraventricular  blood  is  again  noted.  The  intraparenchymal  haemorrhage  centred  on  the  left  basal  ganglia  is  unaltered,  as  is  the  small  haemorrhagic  contusion  in  the  inferior  right  frontal  lobe. 

There  is  some  high  signal  in  the  left  cerebral  peduncle,  likely  due  to  oedema  tracking  from  the  basal  ganglia  haemorrhage.  There is  a  tiny  punctate  focus  of  haemorrhage  seen  in  the  right  dorsal  midbrain and there  are  further  numerous  punctate  foci  of  haemorrhage,  predominantly  within  the  anterior  temporal  lobes  and  frontal  lobes. 

There  are  a  few  scattered  foci  elsewhere  in  the  hemispheres  and the  cerebellum.  There  is  more  extensive  signal  abnormality  and  blood  product  seen  within  the  body  and  right  splenium  of  the  corpus  callosum  than  appreciated  on  CT.   In  these  same  areas  are  also  small  foci  of  diffusion  restriction  on  DWI.  Note  is  also  made  of  similar  T2/FLAIR  signal  abnormality,  punctate  haemorrhage  and  restricted  diffusion  within  the  hippocampal  formations.  Findings  are  all  in  keeping  with  extensive  diffuse  axonal  injury.[/accordion] [/az_accordion_section]


Other Investigations

  • Blood tests:   UEC (in particular, Na+), FBC (for Hb, platelets), Blood glucose level, ABG for CO2 
  • Chest x-ray if intubated 
  • CT Chest Abdo Pelvis if evidence of other trauma
  • Later in the patient’s admission, plasma and urine osmolalities and urine Na+ may be required if dysnatraemia


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