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1. ACUTE CT BRAIN Maj-Sein Kyaw Department of Radiology 12/02/2024

2. Introduction CT imaging has emerged as a cornerstone in the rapid and accurate assessment of various critical conditions affecting the brain. T he main purpose of performing a CT in acute setting of brain is to exclude intracranial haemorrhage.

3. M nemonic for acute CT brain approach, "Blood Can Be Very Bad". B  - blood C  - cisterns B  - brain V  - ventricles B  - bones

4. BLOOD Look for any evidence of bleeding throughout all slices of the head CT. Blood will appear bright white and is typically in the range of 50-100 HU. Basic categories of blood in the brain are E pidural S ubdural I ntraparenchymal/intracerebral I ntraventricular S ubarachnoid.

5. Epidural (lens shaped, does not cross suture lines)

6. Subdural (crescent shaped, does cross suture lines)

7. Intraparenchymal/ intracerbral hemorrhage (high density bleeds most often in the basal ganglia area if due to hypertension )

8. Intraventricular haemorrhage

9. Subarachnoid hemorrhage (due most often to aneurysms, CT sensitivity decreases sharply with time)

10. CISTERNS F our key cisterns ( Circummesencephalic , Suprasellar, Quadrigeminal and Sylvian) Is there blood? Are the cisterns open or efface?

11. Blood in Basal cisterns

12. BRAIN Examine the brain for: Symmetry Grey-white differentiation Shift  Hyper/ hypodenisty  

13. Brain volume - young v old Size of the CSF spaces varies with age

14. Grey matter v white matter White matter is located centrally and appears blacker than grey matter due to its relatively low density

15. Midline shift

16. Hyperdense blood VS Hypodense infarct

17. VENTRICLES Examine for 3 rd , 4 th and lateral ventricles for dilation or compression/shift.

18. BONES Evaluate for fracture.

19. Skull fracture v suture Only one of these is a fracture - but which one? The suture appears jagged and corticated The fracture passes across both inner and outer table of the skull in a straight line

20. Imaging of Acute Stroke

21. Hypo-attenuating brain tissue sign

22. Dense MCA sign

23. Insular ribbon sign

24. CT imaging plays a pivotal role in the early diagnosis and management of acute stroke. Its speed, accessibility, and ability to accurately detect hemorrhage versus ischemia make it an indispensable tool in the emergency setting. A systematic approach is crucial for avoiding misdiagnosis. Conclusion