What are some key radiographic findings indicative of severe TBI on CT imaging?

Indunil Karunarathna @Indunil-Karunarathna

25 April 2024 1 8K Report

Article Optimizing Traumatic Brain Injury Management: A Multidiscipl...

In severe traumatic brain injury (TBI), computed tomography (CT) imaging plays a crucial role in assessing the extent of injury and guiding management. Some key radiographic findings indicative of severe TBI on CT imaging include:

Intracranial Hemorrhage: Severe TBI often presents with various types of intracranial hemorrhage, including:Epidural Hematoma: A biconvex-shaped hemorrhage between the inner table of the skull and the dura mater, typically associated with a fracture of the skull vault, such as a temporal bone fracture. Subdural Hematoma: Accumulation of blood between the dura mater and the arachnoid mater, often associated with tearing of bridging veins. Acute subdural hematomas can cause significant mass effect and midline shift. Subarachnoid Hemorrhage: Bleeding into the subarachnoid space, typically observed as high-density blood within the sulci on CT imaging. It is commonly seen in association with traumatic subarachnoid hemorrhage. Intraparenchymal Hemorrhage: Bleeding within the brain tissue itself, which can be focal or diffuse and may indicate more severe brain injury.

Mass Effect and Midline Shift: Severe TBI can lead to significant mass effect, characterized by displacement of brain structures due to edema, hemorrhage, or space-occupying lesions. Midline shift, where brain structures deviate from the midline, is indicative of increased intracranial pressure (ICP) and can be associated with poor outcomes if not promptly addressed.

Brain Edema: Cerebral edema, characterized by diffuse or focal swelling of the brain parenchyma, is commonly observed in severe TBI. Edema can lead to compression of adjacent structures, exacerbating mass effect and increasing ICP.

Brain Herniation Syndromes: Severe TBI may result in brain herniation, where brain tissue shifts or protrudes into a different compartment within the skull. Examples include:Uncal Herniation: Medial temporal lobe herniates through the tentorial notch, leading to compression of the ipsilateral oculomotor nerve (CN III) and subsequent pupillary dilation (blown pupil). Central Herniation: Downward displacement of the diencephalon and brainstem through the tentorial notch, often associated with global cerebral edema and coma. Tonsillar Herniation: Herniation of the cerebellar tonsils through the foramen magnum, leading to compression of the brainstem and potentially fatal consequences.

Diffuse Axonal Injury (DAI): Severe TBI can cause diffuse axonal injury, characterized by widespread damage to axons throughout the brain. While DAI may not always be evident on initial CT imaging, characteristic findings such as punctate hemorrhages in white matter tracts or corpus callosum can be suggestive.

These radiographic findings are indicative of severe TBI and may necessitate urgent medical or surgical intervention to mitigate further brain injury and improve outcomes. Interpretation of CT imaging should be performed in conjunction with clinical assessment and other diagnostic modalities to guide management effectively.

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