The following patients should undergo CT head scan following TBI:
1. All patients with a history of LOC or traumatic coma
2. Combative patients where clinical assessment is masked by associated alcohol, drugs or extracranial injuries. These patients may require endotracheal intubation , sedation and ventilation to facilitate completion of CT scanning.
The most important role of CT scanning is prompt detection of mass lesion such as extradural or subdural hematomas. Therafter, the degree of brain injury may be quantified by radiological criteria.
Marshal classification of CT scan appearance following traumatic brain injury.
1. Diffuse injury (DI) I - no visible intracranial pathology seen
2. DI II (diffuse injury) - cisterns are present with midline shift 0-5mm, lesion densities present, no high or mixed density more 25mm, may include bony fragments and foreign bodies.
3. DI III (swelling) - cisterns are compressed or absent with ML shift 0-5mm, no high or mixed density > 25mm.
4. DI IV (shift) - ML shift > 5 mm, no high or mixed density > 25mm.
5. Evacuated mass lesion -any lesion surgically evacuated.
6. Non-evacuated mass lesion - High or mixed density lesion > 25 mm, not surgically evacuated.
The criteria are important for:
1. providing an index of injury severity
2. providing criteria for intracranial pressure monitoring
3. comparing the progression of injuries with subsequent scans
4. providing an index for prognosis
the presence of traumatic SAH should be recorded since it is an important index of severity of injury and is relevant for prognostication.
1. All patients with a history of LOC or traumatic coma
2. Combative patients where clinical assessment is masked by associated alcohol, drugs or extracranial injuries. These patients may require endotracheal intubation , sedation and ventilation to facilitate completion of CT scanning.
The most important role of CT scanning is prompt detection of mass lesion such as extradural or subdural hematomas. Therafter, the degree of brain injury may be quantified by radiological criteria.
Marshal classification of CT scan appearance following traumatic brain injury.
1. Diffuse injury (DI) I - no visible intracranial pathology seen
2. DI II (diffuse injury) - cisterns are present with midline shift 0-5mm, lesion densities present, no high or mixed density more 25mm, may include bony fragments and foreign bodies.
3. DI III (swelling) - cisterns are compressed or absent with ML shift 0-5mm, no high or mixed density > 25mm.
4. DI IV (shift) - ML shift > 5 mm, no high or mixed density > 25mm.
5. Evacuated mass lesion -any lesion surgically evacuated.
6. Non-evacuated mass lesion - High or mixed density lesion > 25 mm, not surgically evacuated.
The criteria are important for:
1. providing an index of injury severity
2. providing criteria for intracranial pressure monitoring
3. comparing the progression of injuries with subsequent scans
4. providing an index for prognosis
the presence of traumatic SAH should be recorded since it is an important index of severity of injury and is relevant for prognostication.
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