HEAD and NECK 2 ok.pptx66666666666666666

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1. HEAD AND NECK 2 FACULTY OF MEDICAL TECHNOLOGY Dr. Esam Abusaoud

2. Subarachnoid haemorrhage. Subdural haematoma. Cervical spine injuries.

3. SUBARACHNOID HAEMORRHAGE A type of extra-axial intracranial haemorrhage and denotes the presence of blood within the subarachnoid space. SAH accounts for 3% of strokes.

4. Risk factors Family history. Hypertension. Heavy alcohol consumption. Abnormal connective tissue.

5. Aetiology Causes include: Trauma. Spontaneous: Ruptured berry aneurysm (85%).

6. Clinical presentation Sudden sever headache. Photophobia. Meningism. Loss of consciousness .

7. Radiographic features CT: Diagnosis is suspected when a hyper dense material is seen filling the subarachnoid space, most commonly this is apparent around the circle of Willis. MRI: MRI is sensitive to subarachnoid blood and is able to visualize it well in the first 12 hours, typically as a hyper intensity in the subarachnoid space on FLAIR. MR Angiography and MR Venography are also able to detect a causative aneurysm or another source of bleeding.

8. SUBDURAL HAEMATOMA Is a collection of blood accumulating in the subdural space. It can happen in any age group. Is mainly due to head trauma. 75% of patients present with a severely depressed conscious state. 40% of patient present with pupillary abnormalities.

9. Pathology It occurs mostly due to stretching and tearing (due to shearing forces) of bridging cortical veins as they cross the subdural space to drain into an adjacent dural sinus. SDH are interposed between the dura and arachnoid. Is not limited by sutures. It is limited by dural reflections (falx cerebri, tentorium…) Typically crescent shaped.

10. Radiographic features 85% of SDH are unilateral in adult. 85% of SDH are bilateral in infants. Common sites for SDH are fronto-parietd convexities and the middle cranial fossa.

11. CT/ Acute: A crescent shaped homogeneously hyperdense (>50 HU) extra-axial collection. ↑ Subacute: As the clot ages the density of the SDH starts to drop to (35-40 HU) typically in 3-21 days. Isodense to adjacent cortex. ↔ ± Mass effect and midline shift. ± Thickening of the cortex. Chronic: > 3 weeks old. Hypodense to adjacent cortex or even to CSF (0 HU). ↓

12. MRI/ Aging is a complex process. Acute: T1 …………… ↔/ ↓ to gray matter. T2 ………….… ↓ FLAIR …….... ...↑ Subacute: T1 ……………. ↑ T2 …………….. ↑ FLAIR ……….... ↑ Chronic: T1 ………..… . ↔ to CSF. T2 ………… .… ↔ FLAIR ……. …. ↑

13. CERVICAL SPINE INJURY Can involve the cervical column, intervertebral discs and cervical spine ligaments, and/or cervical spinal cord. The cervical spine accounts for 50% of all spinal injuries.

14. Pathology Patients can have a combination of injuries including: Atlanto- occipital dissection. Occipital spine fractures. Cervical spine fractures. Discoligamentous injury. Anterior sublaxation (posterior ligamentous complex rupture). Facet joint dislocation. Spinal epidural haematoma. Spinal cord injury. Vertebral artery dissection.

15. Aetiology Blunt trauma: -RTA 40%, falls, sport injury… Penetrating trauma: -gunshot injuries, stabbing…

16. Radiographic features The cervical spine radiograph has little roll in the imaging of the cervical spine in adult major trauma as CT is the investigation of choice. The majority of patients are imaged while being immobilized in a cervical spine collar. If the CT is reported as negative, the collar is typically removed. A select few patients nevertheless require further assessment with MRI. MRI is used to assess for discoligamentous injury.

17. Atlanto- occipital dissection

18. Occipital spine fractures

19. Cervical spine dislocation & fracture

20. Discoligamentous injury

21. Cervical spine fractures

22. posterior ligamentous complex rupture

23. Facet joint fracture

24. Facet joint dislocation

25. Vertebral artery dissection

26. Spinal epidural hematoma

27. Good luck