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How's everything going for you? Yeah. All good. All good. How are you? Yeah, I'm good. Just very close to exams now. I've got them in like, two weeks. 00, finals, are they? Yeah, finals, the PSA and the ML and stuff like that. Yeah, that's, that's stressful, man. How do you feel for them? I don't know. Hopefully it's all right. It's the osk, that's the main concern because, um, anything can come up so it's a bit worrying. Yeah. Yeah. Yeah. Now I can imagine. Oh, man, that's so stressful. Um, I'm sure you'll be good though doing like, like, uh, I'm sure you'll be, I'll show you. I'm sure you'll sm, sure. Are you in Imperial again? No, I'm in UC UCI. Thought I thought it was longer one. Um, but, yeah. Ok. Cool. I mean, I'm sure, I'm sure you'll smash it fida. How's everything going for you at the moment? Yeah. All good. I'm on, I'm f one just driving around doing my thing. Uh, things going. Ok. Not, can't really complain too much really. Uh, as far as I can, as far as, as far as what I'm on a psychiatry unit. Uh, the good thing about, like, working, I guess is you don't have to exams for now anyway. I bet. Like, that's gonna change in the future. But, well, yeah. Mm. But for F one, at least you didn't have much in the way of exams. It's quite good. Yeah. And as an F one not really, um, do you know where you're applying for? Uh, hopefully West Midland Central. Ok. It's a Birmingham area, is that right? Yeah. Yeah, essentially you're in London, right? Yeah. Yeah. The problem is for our year. It's all random. So there's a very small chance of getting London, especially after pre allocations. It's so true. It can, it can, it's like, literally pot luck at this point, isn't it? Yeah, essentially it's like a one in three or one in four chance. So it's just not worth it anymore. Yeah. Oh God. Ok. For some reason it's just not letting me log on to, on my phone so I can't really switch on my camera. I don't know why. I don't think that's as big of as an issue. Um, uh, it should be fine, to be honest. Ok. I think the reason is because you can't be joining the call on the same account over two devices because it kind of like you. Yeah, but we've already got like two people viewing more people will join. I guess we start around five fast. Yeah. Sure. Happy with that. Yeah. And then obviously there's a feedback form which people can fit in and then that'll automatically cut out all the feedback. So um yeah. OK. Sounds good. Sounds good. Me. OK. 88. Yeah. 222. So how's the psyche? It? Is it a good experience or? Yeah. No psych is psych is good. Uh It's very different to mainstream medicine. Um I think it's a lot more laid back, a lot more chill, a lot more um like away from hospital medicine, but you've got to do a lot more things yourself. I feel like doing bloods ECG is like a lot more yourself. Um But then again, it's just like a different experience. I think it's getting used to like, like the thing you realize is when you move from like different between different systems like hospital systems or like um uh just like between different department, different between different hospitals. It's like the change system is what actually takes more time to learn than the actual medicine itself. Oh I see. It's just moving from one place to another is a bit time consuming. Yeah, exactly. It's cause like the, the way that you learn how to like, like, I don't know, prescribe something in med school is different to one in, in your ho in this hospital because it's a whole new system and then it's another system for psychiatry. It's just a bit chaotic that way. Um But yeah, and even like some of the equipment is slightly different. So you'll realize that I don't like, in UC, you'll be using like vacuum containers for most of them. But at some hospitals here, a lot of the hospitals here use like mono, which are very different. You're taking blood. So it's just getting used to like all of these equipments and once you get through the, like, um, all of that sort of stuff, um, and you settle in then you kind of find your motor and get going with stuff. But honestly, right now, I mean, focus on exams and then, uh, look forward to your elective. Or have you done your elective? No, my other kids off exams. Yeah. Honestly enjoy. Oh, yes. Enjoy it. Make the most of it. That, that's, yeah, that's a good one to a good one to the m injury. Really? Um, do you know where you're going? Yeah, I'm going to Australia. Oh, yeah, I, in my, I did mine in Australia. Uh, where did you do yours in Australia? I was in Sydney. Oh, nice. Yeah, Melbourne. Yeah. Yeah, I went to me for a bit. Nice. What are you doing in Melbourne? Um, doing neurology and endocrinology at me. Hospital? Nice. That's nice. What did you do yours in? I did mine in sports exercise medicines. Nice. In Sydney. Which is awesome. Awesome. I loved it. Uh, make the most of your time to explore as much as you can. Um, are you going, when are you going in March so March to May. Yeah. Ok. Um, it's, yeah, it's not bad but I think hopefully weather is ok though cause it, it's a wintery time, a winter time especially it can get a bit chilly sometimes, but I'm sure you have a great time. Yeah. Hopefully it'll be much better than studying for exams at the moment. Yeah. I think everything is much better than studying for exams, to be honest. Uh, everything is probably better than that at the moment. But I'm sure you'll get through it and good luck to yourself. I'm sure you will do well, thanks. So, which medical school did you go to? Um, Kings? Oh, nice. Yeah. So it, down in London? Yeah. Yes. How did you find things, like, was it, did you enjoy your time there? Oh, I loved it, man. It was great. I would love to go back. Things is really good. Like, I mean, it's just like you've just got a really good balance of your work life. Like, especially, like, it's, it's a, it's genuinely, you get enough time to do what you want at the same time as, um, like the amount of stuff that you get. That's good to hear. I can't go back. Yeah. Looks like you've got a decent number of people on the call and you just wait a couple more minutes. Ok. Well, actually you've got two, some people left with in, in the meantime. What are your top tips just to, you know, generally about ct head interpretation while we're waiting. Oh, my top tips of what ct head interpretations. Yeah. Oh. I think as a medical student I would probably panic when I see a CT head because I'd have no idea what I'm looking at. And especially if it's something to the brain, it's probably some serious pathology. The first thing I'd say is just, don't panic when you're looking at one and go through things systematically. Um, and then lastly, I'd say familiarize yourself with like common pathology so that, you know what to expect. Um, especially as I'm a student. I see. I see. I mean, as a med student, I don't think there's many presentations that you can really see on CT head. I think it probably will be quite basic. Right? Yeah. I mean, there's, I mean, I'd say there's a like five or six that you'd be able to pick out if you look at your CT head and you'll be like, oh, yeah, that, that looks like this, this looks like that. I'd say there's a few. Yeah. Um Yeah, but we'll go through them today. Yeah. So, yeah, I think you can start the number three. Cool. Sounds good. Um So, hey, everyone. Uh my name is Raul. I'm an F one at Pins Hospital. I just graduated from Kings. Uh And I'd like to talk to you about CT heads if you have any questions feel free to pop them in the chat. Sorry, my camera is not working. I don't know why. It's just not letting me use it so I can't switch you on but feel free to pop questions in the chat and I'm happy to answer them. So today, we're going to look over it. We're gonna cover quite a few different aspects of CT heads. So we're gonna understand the basics of CT heads and see uh why are we using it in clinical practice? Um And why would we think about or why would we think about ordering one? Uh We then mainly focus on our interpretation of CT heads. Uh go through a structured method on whereby you can interpret a CT head. Um and then also recognize the normal anatomical structure, then we'll move on to common pathologies. So this will kind of be integrated with our systematic approach. So we'll look at the common pathologies that we can see throughout um our um CD head, what we're commonly likely to see and especially this is targeted at med school sort of level. So what you'd expect to see especially in your finals kind of level, uh We'll go over the ventricular system and cerebral edema um and then focus on some skull fractures and some facial bone injuries and finally correlate this um clinically and uh see how this involves with the clinical decision making uh to formulate differential diagnoses and how these can be used for in the how this can affect intervention. So cool. So basically what is a CT head? So a CT basically uses x-rays. I like to think of it in a way that an X ray is a two D film and a CT is a 3d film. So it's basically an X ray that's given in three dimensions that gives, that allows you to see cross sections through uh the body. So the way that it works is we fire x-rays through your body. And different parts of your body have different types of attenuation coefficient. And depending on the attenuation coefficient of different parts of the body will determine how much x-ray is absorbed. And uh as some, some parts of the body have high amounts of x-rays, a x-ray being absorbed, whereas some of them have high amounts of x-ray being penetrated through it. And that allows for that differentiation between the two different uh parts of the body and how it can be differentiated on a, on an X ray or a CT scan. So, as you can see here, uh different uh components have different Handfield units. So air generally has very low hands field units. That's why they normally appear quite black um or darker with on CT scans. And you'll see that when you image the lungs water, um or soft tissue in general generally has a hands full unit of zero and this progressively goes up and up and up and you'll notice that bone in general has a very, very high um hands feld unit and that's why it generally appears bright um on your X rays or CT scans. Now, one thing to be aware of is that windowing is often used in CT scans to allow us to enhance the image and improve contrast for specific tissues. So when we are looking at the lungs, for example, we use a different windowing compared to looking at the brain or looking at bones. For example, because these are tissues that are at different densities. And if we use um if we use a whole contrast range, uh we won't be able to identify pathology quite as, quite as clearly. So windowing is really important when we are looking at different uh parts of the body and um looking at imaging, especially CT scans. So let's move on to the approach and what are we looking for? Um on act E head interpretation. What are the steps, what are the pneumonics and how can we help? And how can we get to an I get a good idea of what's going on. So the first step with as with every sort of imaging um imaging procedure, imaging technique, first thing to do is confirm patient details. So what are the, what's the patient's name? What is their hospital number? And what is their date of birth? These are just easy tick mark sur exercises that you can do, especially in an OSK situation, uh confirm that, that you've got the right patient check the date and time that that the scan was a acquired and check if there were any previous scans. So if there's no previous scans in front of you generally ask the examiner, has there been any previous scan that they normally provided to you if there are any? And that allows you to compare the two scans. The next thing we'll go into is terminology. So especially when referring to CT scans, the key t terminologies that you need to remember are hypodense and hyperdense. And really what that that means is that hypodense refers to darker structures and hyperdense refers to brighter structures pretty straightforward. Hyper normally means up or more so brighter and hypodense normally means darker. So it go it goes hand in hand. Now, I know you guys are probably so done with Pneumonics cos it's probably a pneumonic for every single thing under the sun, but generally the CT head one I think is actually quite a good one to remember. And the one that we use is blood can be very bad. Um And that stands for five different aspects. So the first one is your blood um which is the first thing that we look for on a CT head where we're looking for any evidence of any hemorrhages. Uh We look at the system for if there's any basement or any asymmetry uh throughout the brain. Uh Then we go on to the brain and look for tissue asymmetry and uh density followed by looking at the ventricles if there's any dilation or compression. And finally, we look at the bone, if there's any fractures or any abnormalities present, generally as with every imaging uh interpretation or use systematic approach, um It makes you look so much more confident, it makes sure that you don't miss anything. Um and generally is much more um will allow you to make sure that you get the correct pathology as well. Um Especially when doing this in an an osk scenario or uh when you actually are are in training and foundation training. Cool, cool. So let's move on to the first thing that we're going to be looking for in a CT head is blood. So it's important to know how blood can look like in a CT head and where you can t typically tend to see a blood on a CT head. So the first thing to be aware of is what are the types of hemorrhages that you can expect to see in on a CT head. So these four are the most common types of hemorrhages or hematomas that we tend to see. The first one we see is an extradural hematoma. The second one is a subdural, then a subarachnoid and then an intracerebral hemorrhage. Now, I'll go into all of these in the next few slides and you'll be able to see some pictures as well, but it's important that you're aware that these are the few types of hemorrhages and hematoma that we can tend to see things to be aware of. Are the sub subarachnoid hemorrhages can be a bit subtle and extend into ventricular system. And it's important to check the posterior horns of the brain because that is where blood tends to collect. And intracerebral hemorrhages can also be intraventricular or intra uh parenchymal. So, within the brain tissue and I'll go over this in the next few slides. The key thing to remember is what blood appears to be on a CT scan. And now this is quite difficult because it varies with age. In most cases, you will be tending to see patients in the acute phase where they will have an acute bleed, which will be hyperdense on a CT scan. So it'll be quite bright on a CT scan and that's what you tend and tend to see and that's what you'd expect to see. Chronic bleeds generally are more darker and a bit more hypodense. And I'll go over that over the next weeks slides. So you can see what exactly that looks like. And as I said, Wining is critical for um better contrast and detail. So we've got a scan here. Um Anyone wanna give a crack about what this is what they can see po in the chart anything? Mm Cool. OK. So this is an example where this patient has a subdural hemorrhage. So the reason why you can see that this is a subdural hemorrhage is because, oh yes, I got a bleed. There's a bleed on the left side. Yeah. Brilliant. So, um, so this patient has had a bleed on the left side of the brain. This is a subdural hemorrhage because it is crescent or banana shaped and this is how you can see it. I've, I've highlighted that. So I'm gonna go back and forth between the two slides and you can see this area that is hyperdense, which means it's a, it's an acute bleed and the shape of the bleed tells us what type of bleed this is and this is a subdural hemorrhage because of the crescent shape. Now, another thing to notice is that the sulci on the right side of the brain are much more prominent, whereas on the left side of the brain are less prominent. And that's because um the sulci had become effaced, which means that there's an increased amount of pressure in that area and that often needs this sort of squishing or squashing effect, essentially um uh causing this effacement and causing them to be less prominent. Cool. We've got another example here of another CT head scan. Um Any idea what's going on here? Yes. Yeah. OK. So this is an example of an extradural hemorrhage. So this is an extradural hemorrhage because of the biconvex or lemon shaped appearance of the bleed. Now again, I'll go back and forth between the two. You can see that there's a hyperdense region. Uh Yeah, got that selo selenis, got that one. So yeah, this is an extradural uh hemorrhage. So this is because there's a biconvex or lens shaped appearance. Um And this is because you can see a hyperdense region that is biconvex or lens shaped and that suggests a extradural hemorrhage moving on to an e intracerebral hemorrhage. Now, this has a very distinct appearance. And as you can see in this case, there is a hyperdense region in the center of the bleed and that generally corresponds to blood, but the area surrounding it is darker in color and that's, that represents the edema that surrounds the bleed. And this is typically what you, this is typically the appearance that you've seen a CT head, which includes a hyperdense, um central area surrounded by a hypodense or darker areas representing the edema. So this is what you're looking for in terms of a CT head. Uh when you're thinking of an intracerebral hemorrhage or a hemorrhagic stroke cool. So that's all for bleeding and for blood, uh we'll move on to the cyst end because um subarachnoid hemorrhages um mainly fall within this ca uh fall within this category. Now, in most cases, the cysts aren't usually clearly visi visible, but if there is blood present within the cyst or the basal cysts, as we can see in the image on the in the bottom, right, they tend to become much more visible when we get blood in these cysts. That's, that is when we have a subarachnoid hemorrhage. Now, there's loads of loads of different types of systems, which I mentioned to you on the slide, the Ambien system, suprasellar, the quad quadrigeminal and the Sylvian system. Now, they're kind of labeled on the bottom right of the slide. But I really wouldn't expect anyone to really know the names of all the assistants. As long as you know, the systems exist in these positions that is quite good. Um And as long as you know, that, that, that sometimes these systems are also called the basal systems. So the those are quite interchangeable. And as long as you remember those key facts, I think um you're more than you've done more than that's more than needed. So, yeah, this is a slide which shows a subarachnoid hemorrhage and you can see the blood present in those basal systems here. So the blood kind of extends um throughout and that's that brighter hyperdense um material that you can see in the center of um center of the uh CT scan here. And then in my head, a subarachnoid hemorrhage kind of looks a bit like a spider or a star um which I'm kinda looking for um incent which originates in the center of CT scan uh spreading through the systems. And that's generally what the typical sort of exper uh typical sort of uh picture that you'd tend to see. Cool. So moving on from the system to the brain. Now, the brain has several aspects that need to be evaluated when um looking at a CT head. So the first thing and the most important thing to look at is are these two sides symmetrical? Because that is the key thing that's gonna tell you if there's any pathology in the CT head. The next thing to look at is a gray white, white matter, different uh differentiation. So there's normally a key distinction between the gray and white matter and loss of this um can suggest some cerebral edema or early ischemic changes. They're quite hard to notice um when, especially if you are not using high uh definition screens. Uh but sometimes they're much more obvious and can be seen on, on normal normal screens or even on a piece of paper as well. Um signs of ischemia. So we're looking also for signs of ischemia in different parts of the brain. Now, hy ischemia generally is seen as a hypodense area. So it'll be darker compared to surrounding area and that generally indicates an infarction. So typically, that's what you'd see in a subacute stroke. The other thing to look for is mass lesions. So, are there any space occupying lesions present such as tumors or abscesses? And finally, also look for any signs of um uh hydrocephalus, which can be seen as a ventricular enlargement or um some sort of underlying edema. Cool. So let's specifically focus on tumors because tumors are a key aspect of the um CT head scans, which I guess are much more common as a medical student. Or um, one of the few things that I think if you were asked to look at a CT head, uh one of the things that you would be able to identify would be a tumor and uh the way that a tumor looks on a CT head scan is very, very different in different types of, in different um types of types of tumors. Um In most cases, they are a, a certain region which can, which is usually hyperdense or isodense, but they also can be um hypodense depending on if there's bleeding present in that area. And I'm gonna go over some slides and that will deter that will help you identify um areas that show tumors as well. Now, if calcification is present in the tumor or in the surrounding areas, those are generally hi uh hyper dental, they'll see that you'll be seeing those as brighter spots throughout um the brain and that can be seen usually in some blood, uh blood vessels throughout the CT scan. Um mass effect cause displacement of uh brain tissue and edema can also cause displacement of brain tissue but will be seen as a hypodense area. Now, one thing to be aware of is that CT contrast head scans are only really used to look at brain tumors and uh malignancies essentially. Um And that's the typical time you'd request a CT head. With contrast, aside from that most indications of a CT head would be a non contrast CT head. Lots of different types of tumors usually enhance themselves when uh you do a CT contrast compared to a CT non contrast. So, yeah, this is an example of a patient who has had act head. Now, if anyone is there anything that someone can notice on the CT head? So yeah, OK. I'm just gonna go on. So the CT head shows an area of is, this shows a subacute ischemic stroke. This is a sub subacute ischemic stroke because there's an area of hypodensity and it's usually in this wedge shaped pattern that we can kind of see in this CT head scan. I don't know if I can draw on it, but I can't really draw on it. But if you can see that there is a wedge shaped pattern here, I'm not sure if you can see my, my, my um my cursor. But if you compare that to a normal side, this is an a one particular area of hypodensity which is typically seen in a, in a in ischemic stroke. So normally, if a patient's had an acute ischemic stroke, um CT heads would show um no abnormal pathology, there'd normally be no um hypodense areas. But in subacute strokes, that's when we tend to see this darkening or this area um or this patch of hyperdensity um because of and lack of blood supply to that blood area uh to that part of the brain. So this compares it a bit further. So, uh if you look at a acute infarct versus an old infarct, uh or in this case, a subacute infarct versus a chronic infarct, you will see that in the subacute infarct, there's an area of um mild or mild hyperdensity. Whereas in the um in the current CTO which shows an older infarct, there's a much more profound area of hypodensity. So I like to think of it as, as the ischemic stroke gets older, the area gets more hypodense and that sort of tells you paint a bit of a picture of how new or how old the stroke is. So in new strokes, you might not even see any sort of change. Um Whereas a few days, like by subacute, I mean, a few days later and by old, I mean, maybe a month or two later. So this is another key finding of a subacute ischemic stroke. So it's important to look at the MCA because that's the most common area in which you can develop a stroke. So in this case, this patient has a clot in the right MCA. Um and that is also highly suggestive of an acute ischemic stroke. Cool. So moving on to this image here, this CT scan shows a bit of a different picture. One thing we can notice is that there's definitely not any sy symmetry between the two, between the right and left side, on the right side. We notice that there's this area of swelling and it's not only hypodense but it has elements of hypodensity and hyperdensity, which is more um indicative of a glioma or an in or an intracranial mass rather than a subacute stroke. Um What you also notice here is that the ventricles appear to be quite effaced by that by Effa I mean squashed, as I said. So the, the um glioma or intracranial mass in this case, has, has really caused um these ventricles to be effaced. And this is a further example of uh the same CT head with contrast. Um And now you can clearly see where the tumor is and uh differentiated from the edema. So if we go back compared to the initial image where there's all this gray um hypodense hypodense regions, when you use the uh contrast, you can clearly tell where the mass is and where the surrounding edema is. Um So if you see a CT head with contrast in an exam, generally, you're looking for a mass and this is typically the findings that you'd like you'd see moving on. We've got another example here where we can see the uh that this, in this case, uh there's various areas of hypodensity present throughout the brain on both the left and right side. Um as you can see, there is no, the symmetry is it's present, but there's areas of the brain which are asymmetrical here as well. Mainly in the areas in the hypodensity regions. You will notice that some of these areas are circular in shape. And that is typically what we would see um in patients with metastases. So in this case, um a contra a post contrast again, want to once again will enhance these metastases, which we can see in this case by this ring around the metastases me metastatic areas. Um And yeah, so normally, if there's multiple ring enhancing lesions, that's typical of metastases. Whereas if we see a solitary um one single big lesion, that's typically the primary brain tumor as opposed to metastases. Um So looking over the mass effect, um this is I described this mildly earlier, but I will go into a bit more detail here. So if we look at the left two images, um we can see on the right side of the brain, the sulci are clearly very much visible. Whereas on the left side of the brain, the sulci are not visible at all, which means that there has been some sort of swelling or uh mass or something that's going on in the uh left side of the brain that's causing the sulci to basically uh disappear because they're being squashed, the brain tissue is being squashed together. And you can see that on the right two images here where you get ventricular effacement where instead of the sulci where you can see that there is some Sulci uh sulcal um effacement, especially in the area where the blood is, um the sulci are less visible. But you can also see the ventricles are also being squashed in this case, causing ventricular effacement. As I said, effacement just means squashing. The last thing that a mass or blood can do is or edema can do is uh cause a midline shift, which is what you'd see in this patient here. Whereas the midline, you'd expect it to be um right down the center of between the two hemispheres of the brain. If there's an increased swelling on one side, brain, it cause the midline to be shifted or pushed to the other side. And that's a significant sign of um a severe mass effect taking place cool. And then we're gonna finally wrap it up with the uh uh with the last two parts of a CT head scan. So, one of the things that we're looking for is the ventricles and we're looking for any signs of asymmetry or any dilation. Uh Is there any effacement, the effacement who have just gone over recently? And is there any hemorrhages present within the ventricular system? Uh One of the key things that you might notice in um patient is this phenomenon called hydrocephalus. And that's when the uh ventricles appear dilated, which you can see in the CT head scan on the bottom, right, the ventricles appear very dilated and there is lots of CSF in there. CSF is generally a lot darker and that's why it has a black appearance in the uh ventricles of the uh ventricles of the brain in the ventricles, they may also have um a hemorrhage which you can see in the top right image and that generally is seen by a area of um hyperdensity. So, any bright areas in the ventricle suggests that there might be an intracerebral hemorrhage that extends into the ventricles or an intraventricular hemorrhage, hydrocephalus is something that we covered in the uh previous slide where you will generally see that the ventricles appear enlarged. Um and there is a abnormal collection of cerebrospinal fluid. Um Now, this is normally caused by either excessive production or there is a improper drainage of the CSF fluid. And so we got to investigate the cause of it. Uh ventricle effacement is something that I've just covered in terms of um edema bleeds or tumor or mass, which can cause this squashing effect of the ventricles. And the last part of our pneumonic of blood can be very bad is bone. So, bone um is usually assessed using a completely separate window, as I said, um bone has a very high handfilled unit. So it usually appears very bright. So if we want to see any sort of fractures on a bone, it would have to have a completely different windowing as you can see in this case where you can't see any of the brain tissue, but you can clearly see the skull bone. And when you see the skull bone, you can, you can see that there is a fracture in the, in that part of the brain that in that part of the skull there. Um I think it's less common that you'd see this, especially as a finally a medical student. Um But it's just something that you can be aware of. Cool. I've got some examples here. Um of some cases. Uh I'm not sure if we will, I'll, I'll quickly run through them. Um This is an example of a CT head scan. Um We can see a pathology here and I just wanted to ask if anyone can spot it. No. Right. Mhm No. OK. So this is a case where a patient has a subarachnoid hemorrhage. You can see that the cysts here are very much visible, they're filled with blood. You can see that star shaped pattern I described earlier and this area is hyperdense. So this is a patient who has had a subarachnoid hemorrhage. Um This and these are examples of various people who have had a subdural hemorrhage. No, an extra duo hemorrhage. Sorry. And as you can see in this case, there's a lemon shaped um wedge, lemon shaped um sort of picture or a lens shaped picture which is typically what you'd expect to see in an extradural hemorrhage. So some of them are a lot brighter, which is what you tend to see in a more acute setting. Whereas the image on the left is slightly darker or more isodense, which is more suggestive suggestive of a subacute um extradural hemorrhage. Yep. So we've got another example over here. So this is an example of an acute or subacute um ischemic stroke. You can see an area of um hypodensity, especially in the um uh a dis a distinct area of hypodensity, no hyperdense obvious regions can be seen inside of it. So this is typical findings of a subacute ischemic stroke. Um This is an image that we kind of discussed earlier. Um So this is an example of a patient who is uh suffering from an intraventricular hemorrhage. Um because you can see the blood which is a bright areas can be seen in the ventricular area. So typical findings of an intraventricular hemorrhage. Um Yeah. And this picture is a patient of a sub uh subdural hemorrhage. And you can see that the image on the left is a lot more acute because of the brightness of the bleed. And on the right, you can see that dark area which is more suggestive a more chronic um subdural hemorrhage. And finally, I've got this image here of a tumor which you can see in the back of the brain. Um In this case, you can see that post contrast, you can clearly deline delineate the borders of the uh tumor and also see the areas of tissue that are surrounding the tumor that have edema as well. Cool. Um I would highly recommend these two websites, Radiology, Masterclass and GK medics. They're really good to help uh learning about CT head interpretation. So if you guys need any help, I generally really strongly advise these two websites. Cool. Um And thank you very much for listening. Uh If you have any questions pop in and chat, um, feel free to feed, fill out my feedback form. Um I would greatly appreciate it. Yeah, if you guys do for that, the feedback for you also get a certificate, not, so please make sure you do that, by the way. Thanks for running the tutorial, I think. Um Yeah, it was really good. Well, thank you. Thank you. Uh I'm probably gonna leave the call. I'll see you. Ok. Thank you very much. Sure.