Role of Computed Tomography (CT) in diagnosis of urgent head trauma in adult
Background. Head injury is one of the leading causes of morbidity and mortality throughout the world. Fall injury is the main cause of head trauma followed by road traffic accidents (RTA) and physical assault. Every victim with altered level of consciousness must be evaluated for brain injury. Radio...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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Amaltea Medical Publishing House
2018-06-01
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| Series: | Romanian Journal of Neurology |
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| Online Access: | https://rjn.com.ro/articles/2018.2/RJN_2018_2_Art-06.pdf |
| Summary: | Background. Head injury is one of the leading causes of morbidity and mortality throughout the world. Fall injury is the main cause of head trauma followed by road traffic accidents (RTA) and physical assault. Every victim with altered level of consciousness must be evaluated for brain injury. Radiological evaluation has undergone dramatic changes with the advent of computed tomography (CT) as it can precisely defi ne the nature and location of the culprit lesion(s).
Aim and projective. The aims of this study are to identify the major CT scan findings in suspected cases of Head injury.
Materials and methods. This is an exploratory study carried out in the specialized surgical hospital and neurosurgical hospital from October 2016 to July 2017 on patients attending to the emergency department with acute head trauma and examined by spiral computed tomography (CT). All patients undergo a full neurological examination.
Result. The study was conducted on 160 patients, 106 males and 54 females, by males: females = 2: 1, aged 21-64 years, with an average age of 43 years. One hundred twenty patients (75%) had abnormal CT findings, while 40 patients (25%) had normal CT. Patients with blunt (closed) head injury were 126 (78.75%), while 34 patients (21.25%) had penetrating (open) head injury. In this study, the number of patients was 160, 106 (66%) of males and 54 (34%) of females with male to female ratio 2/1. The most common age group was between 20-29 years as shown in (Table 1 and Fig. 1). The patient had severe (closed) head injuries (16%), while 34 patients (21.25%) had an open head injury. Data analysis was performed in this study as shown in Table 2 and Fig. 2 are frequency, consciousness level disorders were found in 62 patients (38.75%), followed by multiple injuries including chest and abdominal injuries in 34 patients (21.2), injury penetration Head in 31 patients (19.3%). After a head injury in 30 patients (18.7%), vomiting over one episode was seen in 17 patients (10.6%), and only 6 patients (3.7%) were provided with signs of fracture at the base of the skull including runny nose Warm CSF, vessels, skull double nerve, battle mark (Mastoid) and raccoon (black) eye. Twenty-one patients (75%) had abnormal CT scan results while 40 (25%) had regular CT as shown in (Table 3 and Fig. 3). CT abnormalities are shown in accordance with the mechanism of infection (Table 3 and Fig. 3), indicating that the swelling of the entire brain occurs mainly in adolescents and children, and the most age group between 20-29 years as shown in Table 1 and Fig. 1), The patient with severe injuries was 16% (10%), while 34 patients (21.25%) had an open head injury. CT resection of the mechanism is less in (Table 3 and Fig. 3), indicating that the brain swelling. There are Road traffic accident (RTA) was the most common cause of acute head trauma seen in 63 patients (39.4%), followed by penetrating injury seen in 34 patient (21.2%), fall from height in 28 patients (17.5%) blunt injury of blast in 25 patient (15.7%) and assault seen in 10 patient (6.2%). Acute head trauma was divided into 3 types according to the Glasgow coma scale (GCS) score including: moderate head trauma (score 9-12) was the commonest type seen in 60 patients (37.5%), 48 (80%) of them had abnormal CT findings, mild head trauma (score 13-15) seen in 53 patients (33.2%), 33 (62.2%) of them had abnormal CT, and severe head trauma (score <8) seen in 47 patients (29.3%), 39 (83%) of them had abnormal CT findings. Skull fracture was the commonest abnormal CT finding, seen in 70 patients (43.7%), followed in order of frequency by: cerebral contusion in 47 patients (29.3%), subgaleal hematoma in 34 patients (21.2%), intracranial air seen in 27 patients (16.8%), epidural hematoma in 15 patients (9.3%), subdural hematoma seen in 12 patients (7.5%) subarachnoid hemorrhage in 11 patients (6.8%), diffuse cerebral edema in 10 patients (6.2%), and intraventricular hemorrhage seen in 8 patients (5%). Eighty-eight patients (55%) had skull x-ray, (62.5%) of them were normal (21.5%) had linear skull fracture, (9.2%) had comminuted fracture and (6.8%) had depressed fracture. The main indication for CT scan was disturbance in the level of consciousness and was found in 62 patients (38.7%). Conclusion. We conclude that CT is now the first imaging technique used after acute head trauma in those places. Where CT scans are available. CT is the preferred imaging technique for assessing head trauma. CT was found highly sensitive in demonstrating fractures and was considered the modality of choice when imaging suspected cases of head injury and in emergency patients due to its accuracy, reliability, safety and wide availability. CT scan is still the primary method for evaluating patients with acute head trauma, which is fast, easy and reliable, and is the best choice for cranial fractures and acute axial or acute intraocular bleeding. CT is the imaging method chosen in the evaluation of patients with acute injuries. CT is valuable in making film diagnosis, as well as excluding alternative diagnosis, or crevice of other pathologies, even among uncooperative patients. Patient monitoring is safe and simple; CT is compatible with other patient install devices. The identity and localization of cranial fracture and bone/metal fragment are easily determined. Evaluation of acute bleeding and mass effects is
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| ISSN: | 1843-8148 2069-6094 |