0:01

Well, I hope that the cases that we have reviewed

0:03

in some of the PowerPoint slides

0:05

have emphasized the need for an organized

0:08

approach to the imaging of patients

0:10

who have had head trauma.

0:12

I've emphasized the use of looking at the soft tissues of

0:16

the scalp and the skull in order to identify, for example,

0:20

the area where the brain or the tissue has been hit

0:25

initially in the coup portion of the damage,

0:28

and then looking opposite that for contrecoup injuries.

0:32

We've emphasized extra-axial collections,

0:34

including epidural hematomas

0:36

and subdural hematomas,

0:38

and the surgical criteria for removal of those collections.

0:43

We also talked about gray matter and white matter injuries

0:46

and the gray-white matter junction injuries,

0:49

particularly as it relates to contusions of the brain,

0:53

parenchymal hematomas, and at the gray-white junction,

0:58

axonal injury.

0:59

Finally, we looked at deep injuries

1:01

that may occur either primarily

1:04

secondary to hematomas,

1:05

or as a consequence of the hemorrhage

1:10

and/or the mass effect associated with the hemorrhage.

1:13

I've also discussed the evolution of hemorrhage over

1:16

the course of time both on CT as well as MRI,

1:20

and what to look for and how to best age the hemorrhage

1:24

as far as whether it represents acute, early subacute,

1:28

late subacute, or chronic hematoma.

1:31

Finally, we went over a number of the secondary injuries that

1:34

can occur after the primary traumatic brain damage,

1:38

and those include vascular injuries such as dissections

1:42

or pseudoaneurysms or strokes,

1:44

or the effect of the mass in the brain,

1:49

leading to herniations.

1:51

We discussed the various herniations,

1:53

including subfalcine herniation, uncal herniation,

1:57

transtentorial herniation, upward cerebellar,

2:00

and downward cerebellar herniations.

2:02

Having an organized approach will allow you to best

2:06

gauge the degree of damage of the brain,

2:09

and utilizing both CT and MRI

2:11

will give a complete prognostic report to the clinicians

2:16

as far as the ultimate outcome.