E³ 121 - Emergency radiology I
1. To understand the different types of brain trauma.
2. To become familiar with the differential diagnosis.
Neurotrauma is a major cause of death and disability and accounts for up to 10% of all emergency department visits. Most patients with head trauma are classified as having minor head injury, defined as no or brief loss of consciousness, amnesia and a Glasgow Coma Score (GCS) of 13-15. Brain injury is, however, fatal in 10% of all head injury patients, while 5-10% suffer permanent serious neurological deficits. A further 20-40% of patients are left moderately disabled. CT is the modality of choice for assessment of brain injury in the acute setting, while MRI is more commonly used as a secondary modality in the subacute or chronic stage. Direct consequences of brain injury include fracture, contusion, haematoma and vascular injury, which are generally well known and easily appreciated. Findings of indirect consequences, however, such as herniation, brain swelling and vascular complications, are sometimes subtle and easy to overlook. In this case-based presentation, I will outline the common findings of direct brain injury consequences and specifically focus on the less common findings of indirect consequences.
1. To understand the different types of peripheral vascular injury.
2. To become familiar with the different imaging techniques.
3. To become familiar with interventional treatment options.
Penetrating vascular trauma is caused by direct vessel damage, which exhibits visible bleeding with an extensive blood loss. Blunt trauma injures vessels by crushing, distraction or shearing which leads to dissection, thrombosis and consequent ischaemia and/or invisible bleeding. Unrecognised and uncontrolled haemorrhage can rapidly lead to the demise of the trauma patient. Unrecognised and untreated ischaemia can lead to limb loss, stroke and multiple organ failure. Proper imaging has to be done to recognise the vascular injury and to decide if surgical or endovascular repair should be used. In injuries caused by high energy and/or high velocity, CT angiography is the method of choice to determine the site of active extravasation or the vessel occlusion even if the patient is in the condition of centralised circulation. Some bleedings are delayed after restoration of systemic blood pressure, especially in pelvic region. In low-energy low-velocity trauma, the development of the signs of vascular trauma could be hidden - ultrasound aims to detect the pseudoaneurysms as well as the intramural haematoma or thrombosis. The imaging of the bleeding artery or occluded vessel is crucial to consequent therapy. The injuries with tissue loss and destruction of the skeleton are preferably indicated to surgical treatment. Where it is possible to penetrate the injured segments by the wire, the endovascular approach is preferable, with the exception of the simple embolization to stop bleeding. During the presentation, the illustrative cases of penetrating injury, the blunt injury including the crossroads of imaging and treatment will be shown.