head injury & head ct
TRANSCRIPT
Paleerat Jariyakanjana, MD
Faculty of Medicine, Naresuan University
25 Oct 2013
Head Injury & Head CT
แนวทางการรกษาการบาดเจ็�บท��ศี�รษะ2008
head injured patient
มี�ประวั�ติแน่�น่อน่วั�าศี�รษะถู�กกระทบ ติรวัจพบมี�บาดแผลท��หน่�งศี�รษะหร�อหน่�าผาก มี�การเปล��ยน่แปลงควัามีร� �สึ$กติ�วัแมี�เพ�ยงชั่��วัขณะ
Low risk Moderate risk High risk
AsymptomaticGCS 15No headache
VomitingLoss of consciousnessDiffuse headachePost-traumatic amnesiaVertigoLarge contusion / laceration / subgaleal hematomaAge <2 or ≥60 yrOn anticoagulant or antiplateletAlcohol intoxication with GCS 14Multiple traumaChild abuseSign of base skull fracture
Skull fractureGCS 13-14 without intoxicationNeurological deficitPenetrating skull injuryPost-traumatic seizure
Observe at home with instruction sheet
Consult neurosurgeon + CT scan
HEAD CT
Trauma
Trauma
Trauma
Trauma
Nontrauma
Acute stroke
Cytotoxic edema Loss of gray/white matter differentiation
• Insular ribbon sign• Disappearing basal ganglia sign
Effacement of cortical sulci Subtle low attenuation
Middle cerebral artery sign
Hypoattenuating brain tissue
Obscuration of the lentiform nucleus
Insular Ribbon sign
Dense MCA sign
Non-trauma
Basal ganglia haemorrhage
Nontrauma
Nontrauma
ANY QUESTIONS?