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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Continuing Medical Education (State CME)
Complete all of your state CME requirements in one convenient place.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Compliance
NewTrack, fulfill, and report on all your radiologists' credentialing and licensing requirements.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
2 topics, 7 min.
8 topics, 32 min.
16 topics, 1 hr. 11 min.
Cerebellar Hematoma with Tonsillar Hernia
3 m.Intraventricular Hemorrhage
5 m.Parenchymal and Subdural Hematoma
5 m.Retroclival Subdural Hematoma
3 m.Acute on Chronic Subdural Hematoma
3 m.Midline Shift
4 m.Recurrent Subdural Hematoma
4 m.Subarachnoid Hemorrhage
5 m.Follow-up Imaging of Brain Trauma
6 m.Venous Epidural Hematoma
3 m.Venous Sinus vs. Arterial Epidural Hematomas
7 m.Evolution of Epidural and Subdural Hematomas
4 m.Diffuse Axonal Injury
9 m.Lucid Interval in Epidural Hematomas
3 m.Brainstem Hemorrhage
8 m.Pediatric Skull Fractures
7 m.6 topics, 28 min.
4 topics, 18 min.
14 topics, 1 hr. 6 min.
Secondary Traumatic Injuries
2 m.Traumatic Intracranial Dissection
5 m.Vertebral Artery Dissection, Pseudoaneurysm
6 m.Arteriographic Evaluation of Dissection
4 m.Traumatic Dissection of the MCA
4 m.Overview of Brain Herniation Types
5 m.Mechanisms of Brain Herniations
9 m.Herniation resulting in Infarction
9 m.Acute Hemorrhage on MRI
6 m.Subacute Hematoma on MRI
7 m.Chronic Hematoma on MRI
8 m.Hyperacute Hematoma on MRI
2 m.CT of Blood
3 m.Brain Trauma Summary
3 m.0:00
This is the same 9-year-old patient
0:03
who I demonstrated previously,
0:05
who had the posterior fossa hemorrhage.
0:08
However,
0:09
I want to look at the bone windows to show you
0:11
the calvarial changes in this individual.
0:14
So, as you can see,
0:16
this patient has soft tissue swelling,
0:19
as well as some air in the subcutaneous tissue,
0:22
likely from a laceration or puncture wound.
0:27
However, you'll also note, as I scroll,
0:29
that the patient has a small area of dark signal intensity
0:32
along the calvarium,
0:33
representing pneumocephalus.
0:36
Let me demonstrate that.
0:37
So this is the area of the pneumocephalus demonstrated,
0:42
and you can see the soft tissue swelling
0:44
with the air more superficially.
0:47
What I want to point out, however, is this area here
0:50
where the patient has a calvarial fracture.
0:54
Let's scroll through that.
0:56
As we move through, you can see that,
0:58
in point of fact, this is a comminuted fracture.
1:01
There's a portion here more posteriorly and a portion
1:05
here more anteriorly.
1:06
You'll note that this fracture,
1:08
although depressed,
1:09
is not depressed by greater than one calvarial thickness.
1:14
It's only about, let's say, 25% to 30%.
1:17
And therefore, this in and of itself,
1:20
were it not for the open wound,
1:22
which we demonstrated shortly,
1:24
would not be treated surgically.
1:27
You'll notice, however,
1:28
that the patient does have another fracture on
1:30
the contralateral side.
1:31
This one as well is nondisplaced
1:35
and would not otherwise be treated surgically.
1:38
As we scroll further inferiorly,
1:40
we see that the degree of the displacement of the anterior
1:44
portion of this fracture is increasing over
1:47
the course of inferior scrolling.
1:50
And eventually, you see that we have this comminuted
1:54
area with air adjacent to the fracture,
1:58
and then some fracture fragments
2:00
that are depressed greater than
2:03
one skull thickness deep,
2:06
and these would have to be treated neurosurgically.
2:09
This is the same patient before who had that fracture
2:12
through the mastoid portion of the temporal bone
2:15
with extension to the middle ear cavity.
2:18
So, again,
2:19
the indications for surgery include an open fracture,
2:22
which is communicating with the outer surface of the skin,
2:28
leading to the high rate of possible meningitis,
2:31
as well as the degree of depression
2:34
greater than one skull thickness deep.
Interactive Transcript
0:00
This is the same 9-year-old patient
0:03
who I demonstrated previously,
0:05
who had the posterior fossa hemorrhage.
0:08
However,
0:09
I want to look at the bone windows to show you
0:11
the calvarial changes in this individual.
0:14
So, as you can see,
0:16
this patient has soft tissue swelling,
0:19
as well as some air in the subcutaneous tissue,
0:22
likely from a laceration or puncture wound.
0:27
However, you'll also note, as I scroll,
0:29
that the patient has a small area of dark signal intensity
0:32
along the calvarium,
0:33
representing pneumocephalus.
0:36
Let me demonstrate that.
0:37
So this is the area of the pneumocephalus demonstrated,
0:42
and you can see the soft tissue swelling
0:44
with the air more superficially.
0:47
What I want to point out, however, is this area here
0:50
where the patient has a calvarial fracture.
0:54
Let's scroll through that.
0:56
As we move through, you can see that,
0:58
in point of fact, this is a comminuted fracture.
1:01
There's a portion here more posteriorly and a portion
1:05
here more anteriorly.
1:06
You'll note that this fracture,
1:08
although depressed,
1:09
is not depressed by greater than one calvarial thickness.
1:14
It's only about, let's say, 25% to 30%.
1:17
And therefore, this in and of itself,
1:20
were it not for the open wound,
1:22
which we demonstrated shortly,
1:24
would not be treated surgically.
1:27
You'll notice, however,
1:28
that the patient does have another fracture on
1:30
the contralateral side.
1:31
This one as well is nondisplaced
1:35
and would not otherwise be treated surgically.
1:38
As we scroll further inferiorly,
1:40
we see that the degree of the displacement of the anterior
1:44
portion of this fracture is increasing over
1:47
the course of inferior scrolling.
1:50
And eventually, you see that we have this comminuted
1:54
area with air adjacent to the fracture,
1:58
and then some fracture fragments
2:00
that are depressed greater than
2:03
one skull thickness deep,
2:06
and these would have to be treated neurosurgically.
2:09
This is the same patient before who had that fracture
2:12
through the mastoid portion of the temporal bone
2:15
with extension to the middle ear cavity.
2:18
So, again,
2:19
the indications for surgery include an open fracture,
2:22
which is communicating with the outer surface of the skin,
2:28
leading to the high rate of possible meningitis,
2:31
as well as the degree of depression
2:34
greater than one skull thickness deep.
Report
Description
Faculty
David M Yousem, MD, MBA
Professor of Radiology, Vice Chairman and Associate Dean
Johns Hopkins University
Tags
Trauma
Skull Base
Neuroradiology
Musculoskeletal (MSK)
Interventional
Infectious
Head and Neck
Emergency
CT
Brain
Bone & Soft Tissues
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