Tag Archives: radiopaedia

Strokes: the quick and dirty

2 Major Types:

1) Ischemic: blood vessel supplying the brain is obstructed by a clot

  • Embolism
  • Thrombosis 

2) Hemorrhagic: blood vessel bursts, blood leaks throughout brain #1 Risk Factor: High blood Pressure Other Risk Factors:

  • Age
  • Sex: Male
  • Ethnicity: African Americans, Mexican Americans, Hawaiians, Asian Americans
  • Smoking
  • Fat, cholesterol-rich diet
  • Overweight
  • Pregnancy
  • Birth-control Pills
  • Smoking
  • Diabetes
  • Renal problems
  • Atrial Fibrillation

Signs of Stroke

  • Sudden, severe headache
  • High blood pressure
  • Problems with vision, reflexes, walking, movement, speaking, coherence
  • Vertigo
  • “Bruit” noise when listening to carotid arteries in neck with stethoscope

Treatment Options:

  • Ischemic: Blood thinners to reduce clots: warfarin, heparin, Coumadin
  • Hemorrhagic: surgery to remove blood in brain, repair damaged blood vessels

Academic life in emergency medicine NIH stroke scale PV card. Great resource:
http://academiclifeinem.blogspot.com/2010/02/paucis-verbis-card-nih-stroke-scale.html

Click continue reading for high yield quickhits on a few specific types of stroke and brain imaging examples Continue reading

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Salter Harris Fractures

Image source = UptoDate

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CT Imaging in Minor Head Injury

For minor head injury patients (GCS 13-15) apply the CCHR or NOC decision making tools to help you decide if a head CT is required.

Canadian CT Head Rule:

Head CT is only required in minor head injury patients with any one of the following:

High Risk Factors (for neurological intervention)

  •  GCS score <15 at 2 h after injury
  • Suspected open or depressed skull fracture
  • Any sign of basal skull fracture (haemotympanum, ‘racoon’ eyes, cerebrospinal fluid otorrhoea/rhinorrhoea, or Battle’s sign)
  • Vomiting ( > two episodes)
  • Age 65 years

Medium Risk Factors (for brain injury on CT)

  • Amnesia before impact >30 min
  • Dangerous mechanism (pedestrian struck by motor vehicle, occupant ejected from motor vehicle, fall from height >3 feet or five stairs)

But the Rules Don’t Apply If:

  • GCS < 13
  •  Patient taking coumadin or had a bleeding disorder
  • Obvious open skull fracture
  • Age < 16 yo
  • Non-traumatic

MDCalc: Canadian CT Head Rule Tool

New Orleans Criteria: 

Presence of one or more of the following seven findings requires a head CT:

  • Headache
  • Vomitting
  • Age > 60 yo
  • Drug or alcohol intoxication
  • Deficits in short-term memory
  • Physical evidence of trauma above the clavicles
  • Seizure

MDCalc: New Orleans Criteria Tool

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