TRAUMATIC BRAIN INJURIES
Closed head injury
Penetrating head injury
Compressive head injury
Concussion
Epidural hematoma
Subdural hematoma
Subdural hygroma
Contusion
Coup and contrecoup
Laceration
Diffuse axonal injury
Hypoxia
Edema
Transtentorial herniation
Cerebellar herniation
Contact injuries | Acceleration injuries |
|---|---|
Skull deformation injuries, local
| Surface strain
|
Remote Vault and basal skull fractures | Deep strain Concussive syndromes Diffuse axonal injury. |
Shock wave injures Contrecoup contusion ICH |
HYPERACUTE EDH
Axial NECT shows a right frontal convex extra axial lesion showing rim of hyperdensity(thin arrow) with a large iso dense component (short arrow) suggesting hyperacute on going bleed. Note the cortical buckling.4
CHRONIC SDH
Axial CECT shows a right frontoparietal concave mixed dense extra axial collection (thin arrow) causing cortical buckling and mid line shift, note the displaced ventricles with subfalcine herniation (thick arrow). Layering of the collection is classical finding of chronicity.6
ACUTE SDH
Axial NECT showing left frontoparietal concave hyperdense collection (thick arrow) with midline shift and subfalcine herniation (thin arrow).7
CONTUSION
Axial NECT showing right frontal hemorrhagic contusion, note the mixture of high and low attenuation lesions (arrow).8
DIFFUSE AXONAL INJURY
Figure A axial NECT showing a focal high attenuation in the region of body of callosum (arrow). Figure B sag t2 W MRI showing a focal high signal intensity in the genu of callosum.9
Figure A axial NECT showing punctuate bleed in the left cerebral peduncle along with interpeduncular SAH (arrows). Axial t2 W MRI showing high signal intensity in the left peduncle (arrow).
Classification of DAI
Stage I: Involves the parasagittal regions of the frontal lobes, periventricular temporal lobes and less likely the parietal and occipital lobes, internal and external capsules, and cerebellum.
Stage II: Involvement of the corpus callosum, in addition to the white matter areas in stage I.
Stage III: Involves the areas associated with stage II, with the addition of brainstem involvement.10
PNEUMOCEPHALUS
Axial NECT showing multiple air pockets in the parenchyma, intraventricular region and in the frontal subdural space (arrows).11
POST-TRAUMATIC INFARCT
Axial NECT in a patient who had sustained a motor vehicle accident showing right hemispherical infarct (arrow). Post-traumatic infarcts occur either due to spontaneous ICA dissection or thrombosis due to shearing injury.12
CRANIAL FRACTURES
REVERSAL SIGN –SIGN OF HYPOXIA
Axial CECT shows diffuse hypodensity of the supratentorial cerebral hemisphere with cerebellum showing normal attenuation (arrows).15
CAROTICOCAVERNOUS FISTULA
Axial CECT shows left orbital proptosis with distended left cavernous sinus and dilated superior ophthalmic vein (arrow).
Usually caused by trauma or spontaneous rupture of the cavernous ICA. Routes of drainage will include superior ophthalmic vein, petrosal sinus, cortical veins, contralateral sinus.