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.
MRI BRAIN
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
