Computed Tomography (CT) of the Head on Head Injury Case at Radiology Teungku Chik Ditiro Sigli Hospital

Preliminary

Head CT examination is an examination using the CT Scan modality to show the organs in the head. This head CT examination is the most commonly performed examination at the Radiology Installation of Teungku Chik Ditiro Sigli Hospital, more than 60% of the examinations using CT scan modalities are head CT examinations, and head injury cases are the most common cases besides infarction. Almost every day there is a demand for head CT with a head injury case.
Head injury is a condition where the head structure has collisions from the outside and has the potential to cause disturbances in brain function.

Anatomy of Head

The scalp consists of 5 layers called SCALP namely; skin, connective tissue, aponeurosis, loose connective tissue and pericranium. Skull bones consist of calvaria bone and skull base, skull bones consisting of frontal, temporal, occipital, parietal bones. While the skull base consists of 3 fossa, namely the anterior fossa, media fossa and posterior fossa.
In the head there are also sutures, which consist of sagittal sutures, coronary sutures and lambdoidea sutures.
Inside the skull there is a brain wrapped in a membrane called meninges, these meninges lining the central nervous system which consists of
duramater, arachnoid and piamater.
The brain is a heavy gelatinous structure in adults around 14 kg. The brain consists of several parts, namely; proensefalon (forebrain) consists of the cerebrum and diensefalon, mesensefalon (midbrain) and rhombensefalon (hindbrain) consisting of pons, medulla oblongata and cerebellum.
Fissures divide the brain into several lobes, namely the frontal lobe, parietal lobe, temporal lobe and occipital lobe.
The brain is supplied by two internal carotid arteries and two vertebral arteries. These four arteries anastomose on the inferior surface of the brain and form the Willis circular. The cerebral veins do not have muscle tissue in the walls that are very thin and have no valves. The vein exits the brain and empties into the cranial venous sinus.

Head Injury Pathology

Head injury is a trauma involving calvaria or skull base and internal organs, which is caused by the mechanical force from the outside so that physical, cognitive and social disturbances arise and are associated with decreased levels of consciousness.
Head injury according to pathophysiology is divided into two, primary head injury and secondary head injury. Primary head injury is a direct consequence of the dynamic mechanism, whereas secondary head injury is further damage because the primary injury continues beyond the limit of skull space compensation.
Bleeding is often found in head injuries, namely epidural hematoma, subdural hematoma and subarachnoid hemorrhage and intracranial hematoma.

Head CT Examination Technique In Head Injury Case At Radiology Installation of Teungku Chik Ditiro Sigli Hospital

1. Patient Identity
   Name: Mr. Zf
   Age: 32 years old
   Sex: Men
   Medical Record Number: 232590
   Address: Sigli
   Diagnosis: Severe head injury
   Examination Date: 9 September 2018

2. Preparation of Tools and Materials
   a. CT equipment: Philips Ingenuity CT 128 Slice
   b. Printer: Agfa Drystar 5300 Laser Imager
   c. Fixation tools
   d. Head Holder

3. Patient Preparation
   There are no special preparations for head CT examination in cases of head injury, patients are just released solid objects such as necklaces.

4. Examination Technique
   Patient position:
   The patient is laid on the examination table in a head position close to the gantry (head first).
   Object Position:
   The head is placed on the head holder. The head is positioned so that the mid sagittal plane of the body is aligned with the longitudinal indicator lights and the interpupilary line is aligned with the horizontal indicator lights. The patient's arm is placed on the stomach or next to the body. To reduce the movement of the forehead and body the patient should be familiarized with a special belt on the head holder and examination table. Knee is given a booster for patient comfort.

Parameter Scan
Scanogram: lateral head
Range: from Cervical 3 to vertex.
Slice Thickness: 1.50 mm
FOV: 242 mm
Gantry tilt: 0 degrees
kV: 120
mAs: 450
Scan time: 8.32 Sec
Length: 180.8 mm
Reconstruction Algorithma:
Soft Tissue:
Window width: 80 HU
Window level: 40 HU
Bone:
Window width: 1500
Window level: 500

1. Examination result

• There is a multiple calvary fracture in the left temporoparietal region.
• There is a curd-shaped hyperdence lesion in the left temporoparietal epidural.
• No midline shifting
• Normal ventricular and cystern system
• Sulci and Guri narrow
  Conclusion:
  Epidural hematoma in the left temporoparietal region with multiple calvary fractures of the left temporoparietal region and brain edema.

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*all images original by: @anroja*

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References: >Healthline - Head Injury >Wikipedia - Head Injury >Radiopedia - CT Head Technique >Kenhub - Head & Neck