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CT Head Interpretation Dr Muhammad Zakwan Zakariya FY2 Doctor NHS Lothian st October 31 18:30 @ BRITISHINDIANMEDICASSOCIATION @BINDIANMEDICS BRITISH INDIAN MEDICAL @BIMA ASSOCIATION BIMA Radiology Crash Course The British Indian Medical Association (BIMA) -The British Indian Medical Association (BIMA) is a national non-profit organisation founded on developing a supportive network amongst students and doctors across the UK -Provides tutorial series, conference events, networking, careers talks, socials and more! -For more information follow us on social media and stay up to date with latest academic events by joining our mailing lists: BIMA Clinical and OSCE series: https://forms.gle/CidGvWAc9YY9WSSs8 BIMA Fundamentals of Medicine & Pathology series: https://forms.gle/KfAgeoX55GPAWqee8 BIMA Radiology Crash Course SPEAKER BIOGRAPHY Dr. Muhammad Zakwan Zakariya BSc (Hons) Medicine, MB ChB (Honours) I am currently an FY2 Doctor in Cardiothoracic Surgery at the Royal Infirmary of Edinburgh. I graduated from the University of St Andrews in 2019 and from the University of Manchester in 2022. My main interests are in Internal Medicine and Medical Education, with regular contributions to local peer-assisted learning organisations since medical school. Outside of work, I enjoy playing the piano and competing in local badminton leagues. BIMA Radiology Crash CourseBIMA Radiology Crash Course Radiology for Finals/FY1s- National Radiology T eaching series run by Foundation level Doctors as part of BIMA National Curriculum 3 October – Chest X-Ray interpretation th 10 October- Abdominal X-Ray interpretation 17 October- Limb X-Ray interpretation 24 October- Interventional Radiology st 31 October- CT Scanning BIMA Radiology Crash CourseMedAll You can answer questions and contribute by using the MedAll chat function. Also able to ask questions using this! BIMA Radiology Crash CourseContents/Objectives 1. Indications for CT Head 2. Basic Principles of CT 3. Normal Anatomy in CT Head 4. Systematic Approach to CT Head Interpretation 5. CT Head SBAs BIMA Radiology Crash CourseIndications for CT Head •Altered mental status •Trauma •Cerebrovascular disease •Headache •Seizure •CNS infection •Tumour BIMA Radiology Crash CourseBasic Principles of CT Coronal Sagittal Axial BIMA Radiology Crash CourseBasic Principles of CT BIMA Radiology Crash CourseBasic Principles of CT BIMA Radiology Crash CourseBasic Principles of CT BIMA Radiology Crash CourseNormal Anatomy in CT Head BIMA Radiology Crash CourseNormal Anatomy in CT Head BIMA Radiology Crash CourseNormal Anatomy in CT Head BIMA Radiology Crash CourseNormal Anatomy in CT Head BIMA Radiology Crash CourseNormal Anatomy in CT Head BIMA Radiology Crash CourseSystematic Approach to CT Head -Confirm patient identifiers -Useful mnemonic: - Blood Key signs of abnormality on CT: - Can : Cisterns - Abnormal tissue density - Be : Brain - Mass effect - Enlargement of the ventricles - Very : Ventricles - Bad : Bone BIMA Radiology Crash CourseCase Presentation 1 A 70-year old gentleman presents to A&E with increasing headache and confusion. He initially tripped over his cat and hit his head on the overhead kitchen cabinet 2 days ago. Left acute subdural haematoma BIMA Radiology Crash CourseBlood - Extra-axial SDH EDH - Crescenteric/concave - Lens shaped - Crosses sutures - (Usually) Does not cross suture - Usually venous bleed lines - Usually arterial bleed - Low pressure feeding system BIMA Radiology Crash CourseBlood - Chronicity BIMA Radiology Crash CourseCase Presentation 2 A 33-year-old gentleman presents with a severe sudden-onset headache associated with vomiting and neck stiffness. He has a history of autosomal-dominant SAH polycystic kidney disease and - Most commonly traumatic - Can be due to rupture of early-onset hypertension. cerebral aneurysm Subarachnoid haemorrhage BIMA Radiology Crash CourseBlood - Intra-axial Intraparenchymal Intraventricular BIMA Radiology Crash CourseCisterns Is there: - Symmetry? - Mass effect/effacement? - Blood? BIMA Radiology Crash CourseCase Presentation 3 A 45-year old lady presents with sudden onset left-sided arm and leg weakness and dysarthria. Right MCA ischaemic stroke BIMA Radiology Crash CourseBrain - Features of Ischaemic Stroke ● Hyperdense vessel segment ● Loss of grey-white matter differentiation ● Cortical hypodensity ● Associated parenchymal swelling/gyral effacement BIMA Radiology Crash CourseBrain - Vascular T erritories BIMA Radiology Crash CourseCase Presentation 4 A 40-year-old woman presents to the Emergency Department with a worsening chronic headache with associated vomiting. She has a history of migraines. Meningioma - Hyperdense homogenous enhancement - Surrounding oedema BIMA Radiology Crash CourseBrain - Tumours Note ring-enhancement post contrast! BIMA Radiology Crash CourseVentricles Hydrocephalus • Communicating • e.g. SAH, normal pressure hydrocephalus • Non-communicating • e.g. tumour, cerebellar haemorrhage BIMA Radiology Crash CourseBone Left frontal extradural haematoma with depressed left skull fracture BIMA Radiology Crash CourseQuestion Time BIMA Radiology Crash Course Question 1 A 72-year-old gentleman presents with sudden onset right homonymous hemianopia. a)Parietal infarct b)Posterior fossa meningioma c)Chronic subdural haematoma d)Occipital infarct e)Cerebral tumour BIMA Radiology Crash Course Question 1 A 72-year-old gentleman presents with sudden onset right homonymous hemianopia. a)Parietal infarct b)Posterior fossa meningioma c)Chronic subdural haematoma d)Occipital infarct e)Cerebral tumour BIMA Radiology Crash Course Question 2 An 80-year-old gentleman presents with a one-week history of headaches. He has a background of thrombophilia and myelodysplastic syndrome. a)Left acute extradural haematoma b)Left acute subdural haematoma c)Left acute-on-chronic subdural haematoma d)Left chronic subdural haematoma e)Left acute intracerebral haemorrhage BIMA Radiology Crash Course Question 2 An 80-year-old gentleman presents with a one-week history of headaches. He has a background of thrombophilia and myelodysplastic syndrome. a)Left acute extradural haematoma b)Left acute subdural haematoma c)Left acute-on-chronic subdural haematoma d)Left chronic subdural haematoma e)Left acute intracerebral haemorrhage BIMA Radiology Crash Course Question 3 A 48-year-old gentleman is admitted to AMU, initially presenting with a 4 month history of intermittent headaches. a)Subdural collection b)Subarachnoid haemorrhage c)Normal appearances d)Cerebral atrophy e)Intraventricular haemorrhage BIMA Radiology Crash Course Question 3 A 48-year-old gentleman is admitted to AMU, initially presenting with a 4 month history of intermittent headaches. a)Subdural collection b)Subarachnoid haemorrhage c)Normal appearances d)Cerebral atrophy e)Intraventricular haemorrhage BIMA Radiology Crash Course Question 4 A 78-year-old lady presents with a chronic headache, and she is increasingly concerned that she is getting more forgetful. She had previously underwent bilateral mastectomy. a) Abnormal low density of white matter representing cerebral oedema b) Areas of high density representing subarachnoid bleeding c) Areas of high density representing recent subdural bleeding d) Areas of high density representing recent intracerebral bleeding e) Areas of normal intracerebral calcification BIMA Radiology Crash Course Question 4 A 78-year-old lady presents with a chronic headache, and she is increasingly concerned that she is getting more forgetful. She had previously underwent bilateral mastectomy. a) Abnormal low density of white matter representing cerebral oedema b) Areas of high density representing subarachnoid bleeding c) Areas of high density representing recent subdural bleeding d) Areas of high density representing recent intracerebral bleeding e) Areas of normal intracerebral calcification BIMA Radiology Crash Course Question 5 A 62-year-old gentleman with an acute onset of right-sided hemiparesis, nonfluent speech and visual hallucinations. His current medications include lisinopril, amlodipine and atorvastatin. a)Left MCA ischaemic stroke b)Left-sided meningioma c)Left intra-axial haemorrhage d)Left cerebral empyema e)Left thalamic calcification BIMA Radiology Crash Course Question 5 A 62-year-old gentleman with an acute onset of right-sided hemiparesis, nonfluent speech and visual hallucinations. His current medications include lisinopril, amlodipine and atorvastatin. a)Left MCA ischaemic stroke b)Left-sided meningioma c)Left intra-axial (thalamic) haemorrhage d)Left cerebral empyema e)Left thalamic calcification BIMA Radiology Crash Course Question 6 A 45-year-old woman was brought in by ambulance unconscious following a road traffic accident. What is the most important clinical finding here? a)Subarachnoid haemorrhage b)Bilateral extradural haematoma c)Bilateral intra-axial haemorrhage d)Bilateral subdural collections e)Calcified left choroid plexus BIMA Radiology Crash Course Question 6 A 45-year-old woman was brought in by ambulance unconscious following a road traffic accident. What is the most important clinical finding here? a)Subarachnoid haemorrhage b)Bilateral extradural haematoma c)Bilateral intra-axial haemorrhage d)Bilateral subdural collections e)Calcified left choroid plexus BIMA Radiology Crash Course References 1. https://www.nice.org.uk/guidance/ng232/resources/imaging-algorithm-pdf-13061125549 2. Case courtesy of Craig Hacking, <a href="https://radiopaedia.org/?lang=us">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/62556?lang=us">rID: 62556</a> 3. Case courtesy of Craig Hacking, <a href="https://radiopaedia.org/?lang=us">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/62571?lang=us">rID: 62571</a> 4. Case courtesy of Craig Hacking, <a href="https://radiopaedia.org/?lang=us">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/62252?lang=us">rID: 62252</a> 5. https://geekymedics.com/ct-head-interpretation/ 6. https://www.radiologymasterclass.co.uk/tutorials/ct/ct_brain_anatomy/ct_brain_anatomy_start 7. https://www.youtube.com/watch?v=fEPVXmRuR70&t=207s 8. Case courtesy of Frank Gaillard, <a href="https://radiopaedia.org/?lang=us">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/55748?lang=us">rID: 55748</a> 9. https://www.casestacks.com/medical-school/radiographic-anatomy/brain/ct-brain-anatomy/ 10. https://www.radiologymasterclass.co.uk/tutorials/ct/ct_brain_anatomy/ct_brain_anatomy_meninges 11. https://www.radiologymasterclass.co.uk/tutorials/ct/ct_brain_anatomy/ct_brain_anatomy_ventricles 12. https://www.radiologymasterclass.co.uk/tutorials/ct/ct_brain_anatomy/ct_brain_anatomy_grey_matter 13. https://www.radiologymasterclass.co.uk/tutorials/ct/ct_brain_anatomy/ct_brain_anatomy_white_matter 14. Case courtesy of Andrew Ho, <a href="https://radiopaedia.org/?lang=us">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/23274?lang=us">rID: 23274</a> 15. Case courtesy of Frank Gaillard, <a href="https://radiopaedia.org/?lang=us">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/35891?lang=us">rID: 35891</a> 16. Case courtesy of Bruno Di Muzio, <a href="https://radiopaedia.org/?lang=us">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/40731?lang=us">rID: 40731</a> 17. https://www.radiologymasterclass.co.uk/gallery/ct_brain/ct_brain_images/subdural_acute_chronic_ct_brain 18. Case courtesy of David Cuete, <a href="https://radiopaedia.org/?lang=us">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/22770?lang=us">rID: 22770</a> 19. Case courtesy of David Puyó, <a href="https://radiopaedia.org/?lang=us">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/20297?lang=us">rID: 20297</a> BIMA Radiology Crash Course THANK YOU FOR LISTENING Please do complete the Feedback form to obtain your certificate! BIMA Radiology Crash Course