CLINICAL APPROACH TO CT BRAIN

TEE CHEN GIAP

Just another medical student stuck at home

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Anatomy Recognition
DESCRIBE THIS CT SCAN.
NORMA
L

Intro System Clinical Integrate Pattern Interpret Q&A 1 Cases Q&A 2

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 Intuition

Sir
HISTORY OF CT
Allan
Godfrey
Cormack
Hounsfield

Dr. William H.
Oldendorf
 DISCLAIMER
CT BRAIN for today,
ENT sinuses, sagittal/coronal views, base of skull etc
May be topics for another time  only briefly

OUR OBJECTIVES
and no…. No MRIs 

 To give EVERYONE here a SYSTEMATIC approach to CT Brain (axial).

 To share what I find works well in CT Brain Interpretation.

 To translate what we’ve learnt in Pre-Clinicals and textbooks, onto CT Brain

 To hopefully, make more of us competent undergraduate CT Brain Interpreters,

for incoming clinical practice. Not all to be Radiologists! (Physicians woo!)

 At least be able to come up with something during OSCEs :P

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CT SCAN

Common Indications:
1. Polytrauma
2. Altered GCS
3. Headache with W/S
4. Seizure
5. T.B.I.
6. Neurological Deficits
7. Raised ICP
8. Basal Skull #
9. Hypoxia

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 Hyperdense

Isodense

Hypodense

Super dense Giap +9999

The denser it is, the whiter it appears on CT.

Density: Grey Matter > White Matter, therefore appears whiter!

Real Life: White – Grey – White

CT: Grey – White – Grey

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A SYSTEM TO CT BRAIN ANALYSIS
Identification ISSUES:
Settings, View, Contrast + Anatomy?

“Blood Can Be Very Bad” + Level?

Blood
Cistern + Structures?
Brain
Ventricles + Wait is that blood in the
middle?
Bone

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CLINICAL ANATOMY

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Never forget:
Monroe-Kellie Doctrine
 INTEGRATION
Identification
Settings, View, Contrast
“Blood Can Be Very Bad”

Tackling:
+ Anatomy?
+ Level?
+ Structures?

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INTEGRATION

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C
PRO TIP –
If you can’t remember a single thing (in OSCE)
because you’ve been stunned by my beautiful voice
(probably coz Giap’s bad at teaching) Right
Intracerebral
“REGIONS” Ischemia

Right
Frontotemporal
Ischemia

Right
Frontal Lobe
MCA ischemia
involving the caudate
nucleus

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Anatomy Error 404 Recognition
PRO TIP# 2 –
NEVER COMMENT ON
SOMETHING YOU ARE NOT
SURE OF IN EXAMS

I.R.L: PLEASE CONTINUE TO

LEARN! ASK THE
RADIOLOGIST/SUPERVISOR
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Anatomy Error 404 Recognition
PATTERN RECOGNITION
LUCID INTERVAL

Acute on Chronic
Subdural
Hematoma

Extradural Acute Subdural Subarachnoid

Hematoma Hematoma Hemorrhage @
suprasellar cistern
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PATTERN RECOGNITION

Hydrocephalus

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PATTERN RECOGNITION

Cerebral Abscess
@ Right
Temporal Lobe

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PATTERN RECOGNITION

Intracranial Tumour
@ Right Fronto-
Parietal Region
(Metastasis)
before and after
contrast

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Watershed
Infarct
ACA-MCA

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 SLIGHTLY
ADVANCED
STUFF

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CEREBRAL 2 other cerebral edema types
Osmotic & Hydrostatic Cerebral Edema

EDEMA TYPES

CYTOTOXIC VASOGENIC
CELL DEATH BBB Involvement
Both White Grey White Matter
Involvement Grey finger-like
projections
Seen in:
Ischemia Seen in:
Hypoxia Tumours
(ATP Depletion) Trauma
Infarct

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CT – MCA SIGNS

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 Questions?
Before we attempt the cases

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 CASES

Remember, it’s super okay to make mistakes now!

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 CASE 1

Hydrocephalus

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 CASE 2
A young man
came to A&E Left Fronto-
Parietal Acute
after a flower Extradural
pot fell onto Hematoma
his head.

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 CASE 3

50 years old
gentleman, H/O
Hypertension Acute
3 days Rt Hand Pontine Hemorrhage
Weakness and
Dizziness

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 CASE 4
chronic subdural hematoma affecting the
left fronto-temporal region.

There is mass effect with a midline shift of

approximately 7 mm to the right.
65 years old gentleman,
Confusion and shortness of There is age-appropriate brain atrophy.
breath in a patient with past There is moderate periventricular and
subcutaneous cortical white matter
medical history of alcohol hypoattenuation most commonly seen in
abuse. chronic small vessel ischemia.

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 CASE 5
Showed a mature
infarct in the left
perisylvian  cortex,
70y/o gentleman clearly depicting the
'loss of insular ribbon
Presented with right sign'.
sided weakness. history
of previous stroke Early Left MCA Infarct!
episode

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 Final Questions?

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 Thank you very much

Stay tuned for the next lineup of peer lectures!

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