Brain Computed Tomography Scan Research Articles

Incidental findings in brain CT scans of patients with head trauma

Objective: Incidental findings (IFs) are newly discovered abnormal findings unrelated to the primary purpose of imaging. Brain computed tomography (CT) scan is one of the most essential and initial imaging evaluations for head trauma patients, which may also have nontraumatic IFs. We aim to investigate the prevalence and nature of IFs in brain CT scans of head trauma patients. Methods: We conducted a cross-sectional study to evaluate brain CT scans of 1006 head trauma patients over one year (April 2021 to March 2022), to identify incidental findings by consensus agreement of two radiologists. We categorized the incidental findings into four categories based on appropriate follow-up recommendations. Results: We included 1006 head trauma patients who underwent brain CT scan, of which 126 incidental findings were discovered in brain CT scan of 107 patients. The prevalence of incidental findings was 10.6% (107/1006). The most common incidental finding was brain atrophy (n=15, 11.9%). The mean age of patients with IFs was significantly higher than those without IFs, but there was no difference between the two groups regarding gender. Conclusion: The discovery rate of incidental findings of brain CT scans in head trauma patients was considerable. Serious medical findings that need immediate evaluation were found in 5.6% of patients, mostly over the age of 40. Therefore, patients who have clinically significant incidental findings need improved documentation and follow-up to evaluate the long-term outcomes and reliability of imaging results.

Evaluation of Facial Aging in Different Age and Gender Groups With Computed Tomography-Based Calvarium and Face Measurements.

The human face is a complex area formed by the combination of many different components and varies among individuals according to gender, age, and ethnicity. The aim of this study was to evaluate age-related changes in the facial and calvarial bones in a large sample of both genders. The retrospective study included nontraumatic brain computed tomography scans of 280 Turkish adults. Participants were divided into 7-decade groups with the age ranging from 20 to 89 years. Measurements of the face and calvaria were recorded, and calvarial volume was calculated. The relationship of these parameters with age and gender was examined. Statistically significant differences were observed in all the facial and calvarial measurements, except the transverse diameter of the head, with increasing age in both genders. Regardless of age, no significant differences were found in facial and calvarial measurements between genders. In addition, there was a significant decrease in the calvarial volume in both genders after the seventh decade of life. The structure of the face and calvarium continues to change and differentiate throughout life. Taking these changes into account during surgical and facial rejuvenation procedures can help predict outcomes and avoid the use of incorrect techniques.

Evaluation of Admission Brain Computed Tomography Findings to Predict the Long-Term Outcomes of Patients with Traumatic Brain Injury

Abstract Objective To evaluate the admission brain computed tomography (CT) scan findings in patients with traumatic brain injury (TBI) in a low- and middle-income country (LMIC) to predict long-term neurological outcomes. Materials and Methods Patients admitted to a tertiary emergency hospital between March 2017 and April 2018 who had suffered a TBI and had undergone a brain CT scan within 12 hours of the trauma were prospectively evaluated. All of the patients who were hospitalized for at least 24 hours were contacted by phone after 12 months to evaluate their neurological condition. Results We achieved a 12-month follow-up with 180 patients, most of them male (93.33%). The brain changes identified by CT, such as brain contusion (BC; p = 0.545), epidural hemorrhage (EDH; p = 0.968) and skull base fracture (SBF; p = 0.112) were not associated with worse neurological outcomes; however, subdural hemorrhage (SDH; p = 0.041), subarachnoid hemorrhage (SAH; p ≤ 0.001), brain swelling (BS; p ≤0.001), effacement of cortical sulci (ECS; p = 0.006), effacement of basal cisterns (EBC; p ≤0.001), depressed skull fracture (DSF; p = 0.017), and a brain midline shift > 5 mm (p = 0.028) were associated with worse outcomes. Conclusion Findings such as SAH, BS and DSF were independent predictors of worse neurological outcomes. The rate of 70% of patients lost to follow-up shows the difficulties of conducting long-term research in LMICs.

Association between Peripheral Arterial Lactate Levels and Malignant Brain Edema Following Endovascular Treatment for Ischemic Stroke

Aims: To investigate the factors of postoperative malignant brain edema (MBE) in patients with acute ischemic stroke (AIS) treated with endovascular treatment (EVT). Background: MBE is a severe complication following EVT for AIS, and it is essential to identify risk factors early. Peripheral arterial lactate (PAL) levels may serve as a potential predictive marker for MBE. Objective: To determine whether immediate postoperative PAL levels and the highest PAL level within 24 hours of EVT are independently associated with MBE development in AIS patients. Methods: We retrospectively analyzed patients with AIS who underwent EVT from October 2019 to October 2022. Arterial blood was collected every 8 h after EVT to measure PAL, and record the immediate postoperative PAL and the highest PAL level within 24 h. Brain edema was evaluated using brain computed tomography scans within 7 days of EVT. Results: The study included 227 patients with a median age of 71 years, of whom 59.5% were male and MBE developed in 25.6% of patients (58/227). Multivariate logistic regression analysis showed that the immediate postoperative PAL (odds ratio, 1.809 [95% confidence interval (CI), 1.215-2.693]; p = 0.004) and the highest PAL level within 24 h of EVT (odds ratio, 2.259 [95% CI, 1.407-3.629]; p = 0.001) were independently associated with MBE. The area under the curve for predicting MBE based on the highest PAL level within 24 hours of EVT was 0.780 (95% CI, 0.711-0.849). Conclusion: Early increase in PAL levels is an independent predictor of MBE after EVT in AIS patients.

Streptococcus intermedius causing primary bacterial ventriculitis in a patient with severe periodontitis - a case report

BackgroundStreptococcus intermedius is a member of the S. anginosus group and is part of the normal oral microbiota. It can cause pyogenic infections in various organs, primarily in the head and neck area, including brain abscesses and meningitis. However, ventriculitis due to periodontitis has not been reported previously.Case presentationA 64-year-old male was admitted to the hospital with a headache, fever and later imbalance, blurred vision, and general slowness. Neurological examination revealed nuchal rigidity and general clumsiness. Meningitis was suspected, and the patient was treated with dexamethasone, ceftriaxone and acyclovir. A brain computer tomography (CT) scan was normal, and cerebrospinal fluid (CSF) Gram staining and bacterial cultures remained negative, so the antibacterial treatment was discontinued. Nine days after admission, the patient’s condition deteriorated. The antibacterial treatment was restarted, and a brain magnetic resonance imaging revealed ventriculitis. A subsequent CT scan showed hydrocephalus, so a ventriculostomy was performed. In CSF Gram staining, chains of gram-positive cocci were observed. Bacterial cultures remained negative, but a bacterial PCR detected Streptococcus intermedius. An orthopantomography revealed advanced periodontal destruction in several teeth and periapical abscesses, which were subsequently operated on. The patient was discharged in good condition after one month.ConclusionsPoor dental health can lead to life-threatening infections in the central nervous system, even in a completely healthy individual. Primary bacterial ventriculitis is a diagnostic challenge, which may result in delayed treatment and increased mortality.

Tetralogy of Fallot complicated by multiple cerebral abscesses in a child: a case report

IntroductionBrain abscesses are rare but potentially fatal condition and can be associated with cyanotic congenital heart disease of which 5–18.7% of these patients that develop cerebral abscess commonly have tetralogy of Fallot (TOF).Case presentationWe report a case of 3-year-old Muganda male that presented with convulsions, cyanosis and difficulty in breathing. The patient had a combination intervention of medical treatment and surgical drainage of the abscess. Post-operative Computerized tomography scan images and pre-operative brain Computerized tomography scans were compared. The multiple rings enhancing lesions were reduced in number and sizes. The largest measured ring was 44 × 22.5×16mm compared to the previous; 42 × 41×36mm. The mass effect had reduced from 16 mm to 7.5 mm. The periventricular hypodensities persisted. Findings showed radiological improvement with residual abscesses, subacute subdural hematoma and pneumocranium. The patient was treated with intravenous ceftriaxone 1 g OD for six weeks and he showed marked improvement and was discharged home after 3 months.ConclusionA comprehensive strategy involving medications, surgical drainage, and early neurosurgical consultation is vital in treating brain abscesses in uncorrected TOF. Early identification of the pathogen, appropriate antibiotic therapy, and vigilant follow-up through clinical assessments and imaging are crucial, potentially spanning a 4–8-week treatment.

Diagnostic Utility of Glial Fibrillary Acidic Protein Beyond 12 Hours After Traumatic Brain Injury: A TRACK-TBI Study.

Blood levels of glial fibrillary acidic protein (GFAP) and ubiquitin carboxyl-terminal hydrolase-L1 (UCH-L1) within 12h of suspected traumatic brain injury (TBI) have been approved by the Food and Drug administration to aid in determining the need for a brain computed tomography (CT) scan. The current study aimed to determine whether this context of use can be expanded beyond 12h post-TBI in patients presenting with Glasgow Coma Scale (GCS) 13-15. The prospective, 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study enrolled TBI participants aged ≥17 years who presented to a United States Level 1 trauma center and received a clinically indicated brain CT scan within 24h post-injury, a blood draw within 24h and at 14 days for biomarker analysis. Data from participants with emergency department arrival GCS 13-15 and biomarker values at days 1 and 14 were extracted for the primary analysis. A subgroup of hospitalized participants with serial biomarkers at days 1, 3, 5, and 14 were analyzed, including plasma GFAP and UCH-L1, and serum neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100B). The primary analysis compared biomarker values dichotomized by head CT results (CT+/CT-). Area under receiver-operating characteristic curve (AUC) was used to determine diagnostic accuracy. The overall cohort included 1142 participants with initial GCS 13-15, with mean age 39.8 years, 65% male, and 73% Caucasian. The GFAP provided good discrimination in the overall cohort at days 1 (AUC = 0.82) and 14 (AUC = 0.72), and in the hospitalized subgroup at days 1 (AUC = 0.84), 3 (AUC = 0.88), 5 (AUC = 0.82), and 14 (AUC = 0.74). The UCH-L1, NSE, and S100B did not perform well (AUC = 0.51-0.57 across time points). This study demonstrates the utility of GFAP to aid in decision-making for diagnostic brain CT imaging beyond the 12h time frame in patients with TBI who have a GCS 13-15.

Imaging Findings in Acute Traumatic Brain Injury: a National Institute of Neurological Disorders and Stroke Common Data Element-Based Pictorial Review and Analysis of Over 4000 Admission Brain Computed Tomography Scans from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study.

In 2010, the National Institute of Neurological Disorders and Stroke (NINDS) created a set of common data elements (CDEs) to help standardize the assessment and reporting of imaging findings in traumatic brain injury (TBI). However, as opposed to other standardized radiology reporting systems, a visual overview and data to support the proposed standardized lexicon are lacking. We used over 4000 admission computed tomography (CT) scans of patients with TBI from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study to develop an extensive pictorial overview of the NINDS TBI CDEs, with visual examples and background information on individual pathoanatomical lesion types, up to the level of supplemental and emerging information (e.g., location and estimated volumes). We documented the frequency of lesion occurrence, aiming to quantify the relative importance of different CDEs for characterizing TBI, and performed a critical appraisal of our experience with the intent to inform updating of the CDEs. In addition, we investigated the co-occurrence and clustering of lesion types and the distribution of six CT classification systems. The median age of the 4087 patients in our dataset was 50 years (interquartile range, 29-66; range, 0-96), including 238 patients under 18 years old (5.8%). Traumatic subarachnoid hemorrhage (45.3%), skull fractures (37.4%), contusions (31.3%), and acute subdural hematoma (28.9%) were the most frequently occurring CT findings in acute TBI. The ranking of these lesions was the same in patients with mild TBI (baseline Glasgow Coma Scale [GCS] score 13-15) compared with those with moderate-severe TBI (baseline GCS score 3-12), but the frequency of occurrence was up to three times higher in moderate-severe TBI. In most TBI patients with CT abnormalities, there was co-occurrence and clustering of different lesion types, with significant differences between mild and moderate-severe TBI patients. More specifically, lesion patterns were more complex in moderate-severe TBI patients, with more co-existing lesions and more frequent signs of mass effect. These patients also had higher and more heterogeneous CT score distributions, associated with worse predicted outcomes. The critical appraisal of the NINDS CDEs was highly positive, but revealed that full assessment can be time consuming, that some CDEs had very low frequencies, and identified a few redundancies and ambiguity in some definitions. Whilst primarily developed for research, implementation of CDE templates for use in clinical practice is advocated, but this will require development of an abbreviated version. In conclusion, with this study, we provide an educational resource for clinicians and researchers to help assess, characterize, and report the vast and complex spectrum of imaging findings in patients with TBI. Our data provides a comprehensive overview of the contemporary landscape of TBI imaging pathology in Europe, and the findings can serve as empirical evidence for updating the current NINDS radiologic CDEs to version 3.0.

Optimizing Intracranial Hemorrhage Detection: A Comparative Study of VGG Deep Learning Architectures with Transfer Learning on CT Brain scans

Intracranial Hemorrhage (ICH) is a life-threatening condition that requires rapid and accurate diagnosis. This study applied Visual Geometry Group (VGG) deep learning model to binary classification of cerebral hemorrhage in Computerized Tomography (CT) brain scans, thereby improving the diagnostic process. Using a Kaggle dataset containing 6703 images, this study investigated the validity of VGG11, VGG13, VGG16, and VGG19 architectures, using transfer learning of ImageNet pre-trained weights to improve model performance. This study showed that VGG13 with transfer learning outperformed other models with 99.70% accuracy, indicating the profound impact of pre-trained weights on diagnostic accuracy. VGG models with untrained weights performed differently, with VGG11 achieving 98.61% accuracy, suggesting that less complex models were better suited to specific tasks. Comparative analysis shows that the depth of neural networks and the initialization of pre-training weights are the key factors to optimize performance. The discoveries present encouraging possibilities for integrating Artificial Intelligence (AI) into emergency medical services, with the potential to enhance the detection of cerebral hemorrhage and subsequently improve patient outcomes. While acknowledging limitations associated with dataset diversity and model generalization, the outcomes underscore the importance of tailoring models to specific task requirements. These findings also advocate for additional empirical research to fine-tune and advance the application of AI in healthcare.

Long-term complications of permanent hypoparathyroidism in adults: prevalence and associated factors.

Patients with Chronic hypoparathyroidism (CHPT) receiving conventional treatment are exposed to several long-term complications including basal ganglia calcifications, posterior subcapsular cataract, kidney stones, and renal insufficiency. The aim of this study was to assess the prevalence and the associated factors of these complications in patients with CHPT. We conducted a cross-sectional study including 58 patients with CHPT. All participants underwent physical examination, biochemical assessment (total serum calcium, serum phosphorus, serum albumin, intact-PTH, serum magnesium, 25-hydroxy-vitamin D, serum creatinine, thyroid stimulating hormone (TSH), and 24-hour urinary calcium), slit lamp examination, brain computed tomography scan (CT-scan), and renal ultrasound. Participants had a mean age of 52.6 ± 16.4 years and a gender ratio (women/men) of 3.5. Fahr syndrome, cataract, urolithiasis, and renal failure were found in 55%, 62%, 12%, and 17% of cases, respectively. CHPT duration >15 years (Adjusted-OR = 43.1, 95-CI: 2.63-703.06, p = 0.008) and poor adherence to treatment (Adjusted-OR = 8.04, 95%-CI: 1.52-42.42, p = 0.014) were independently associated with the risk of Fahr syndrome. Age >55 years (adjusted-OR = 5.07, 95-CI: 1.10-23.42, p = 0.037), disease duration >15 years (adjusted-OR = 20.21, 95-CI: 1.54-265.84, p = 0.022), and magnesium level <0.8 mmol/l (adjusted-OR = 36.46, 95-CI: 3.75-354.08, p = 0.002) were independently associated with the risk of subcapsular cataract. Only hypercalciuria (Adjusted-OR = 21.27, 95-CI: 2.31-195.91, p = 0.007) was an independent risk factor for kidney stones. Renal failure was not associated with kidney stones (p = 1). However, creatinine clearance was negatively correlated with age (r = -0.784; p < 10-3) and disease duration (r = -0.352; p = 0.007). Our results revealed high prevalences of neurological, ocular, and renal complications in patients with CHPT and emphasized the importance of regular biological monitoring, therapeutic adjustments, screening, and adherence to treatment in the prevention of these complications.

Modified ResNet152v2: Binary Classification and Hybrid Segmentation of Brain Stroke Using Transfer Learning-Based Approach

Abstract Introduction: The brain is harmed by a medical condition known as a stroke when the blood vessels in the brain burst. Symptoms may appear when the brain’s flow of blood and other nutrients is disrupted. The World Health Organization (WHO) claims that stroke is the leading cause of disability and death worldwide. A stroke can be made less severe by detecting its different warning symptoms early. A brain stroke can be quickly diagnosed using computed tomography (CT) images. Time is passing quickly, although experts are studying every brain CT scan. This situation can cause therapy to be delayed and mistakes to be made. As a result, we focused on using an effective transfer learning approach for stroke detection. Material and methods: To improve the detection accuracy, the stroke-affected region of the brain is segmented using the Red Fox optimization algorithm (RFOA). The processed area is then further processed using the Advanced Dragonfly Algorithm. The segmented image extracts include morphological, wavelet features, and grey-level co-occurrence matrix (GLCM). Modified ResNet152V2 is then used to classify the images of Normal and Stroke. We use the Brain Stroke CT Image Dataset to conduct tests using Python for implementation. Results: Per the performance analysis, the proposed approach outperformed the other deep learning algorithms, achieving the best accuracy of 99.25%, sensitivity of 99.65%, F1-score of 99.06%, precision of 99.63%, and specificity of 99.56%. Conclusions: The proposed deep learning-based classification system returns the best possible solution among all input predictive models considering performance criteria and improves the system’s efficacy; hence, it can assist doctors and radiologists in a better way to diagnose Brain Stroke patients.

Reporting rates and presence of dental pathology on CT brain examinations at a tertiary hospital in Johannesburg, South Africa

South Africa is burdened by a high prevalence of dental pathology. It is common to encounter this dental pathology on computed tomography (CT) brain scans. Aims and objectivesTo determine the presence of dental pathology on CT brain scans performed in a tertiary hospital and to assess whether radiologists reported on the encountered pathology. The study aimed to raise awareness among radiologists on reporting dental pathology and highlight the impact this has on oral and general health.DesignA retrospective observational study.MethodsReports of CT brain scans performed between September 2019 and October 2019 were reviewed for dental findings. Two radiologists, Reader 1 and Reader 2, blinded to the reports’ findings, reevaluated the corresponding CT images. Their findings were compared with the findings of the reports.ResultsNone of the 160 reports reviewed had dental findings. Reader 1 and Reader 2, respectively, reported dental pathology in 92% and 79% of the CT scans. The most common dental findings were dental caries (79% and 53%), followed by missing teeth (66% and 53%), periodontal disease (59% and 38%), periapical disease (54% and 29%), odontogenic sinusitis (19% and 3%), restorations (11% and 9%) and dental injuries (4% and 4%).ConclusionsRadiologists do not report on dental pathology encountered on CT brain scans. Recognition of dental findings may alter patient management and reduce related morbidity and mortality.

A RARE CASE : HOMONYMOUS HEMIANOPIA IN CHILDREN

Abstract&#x0D; Introduction : Homonymous hemianopia (HH) is a visual field loss in the same halves of the visual field of each eye that is caused by numerous lesion affecting the retrochiasmal visual pathway. Homonymous hemianopia in children is a rare disabling condition and might be found as an initial presentation of brain tumors.&#x0D; Case Illustration : A 12 years old boy came with chief complaint of partially vision loss on the left side of vision accompanied by intermittent headache. Ophthalmological examination showed visual acuity of 1.0 on both eyes. Visual field examination revealed left homonymous hemianopia (figure 1). These findings were relevant to the result of his brain Computed Tomography (CT) scan, which showed vascular mass in the right occipital lobe caused by suspected arteriovenous malformation mixed diffuse type (figure 2). The patient was referred to neurosurgeon for further management.&#x0D; Discussion : Visual field defect depends on location of the lesion and can be used to recognize optic pathway diseases. Homonymous hemianopia occurs in retrochiasmal lesions that could happened either in adult or children. Unusual presentation of HH in children caused by brain tumor such as arteriovenous malformation. It might occur in up to 27% and can be detected radiologically with either brain CT scan or Magnetic Resonance Imaging (MRI).&#x0D; Conclusion : Visual field loss in pediatric patient might be challenging. Proper and prompt diagnosis is important to detect underlying condition and determine further management of the patient.

Role of Uttarabasti in Neurogenic Urinary Incontinence

Neurogenic bladder refers to dysfunction of the urinary bladder arising from internal or external trauma, disease, or injury of the central, autonomic or somatic nervous system in the control of micturition. Depending on the nerves involved and the nature of the damage, bladder becomes either overactive or underactive and this usually presents clinically as urinary incontinence or retention of urine. Urinary Incontinence (UI) is a hygienic problem and is one of the troublesome, important cause of morbidity and impairment of quality of life, in both men and women. It may lead to recurrent UTI and ascending infections which affect the functioning of kidney. Deranged function of Vatadosha especially Apanavata along with Pranavata and Vyanavata are the main culprits of neurogenic bladder. Vitiated Doshas cause Mootravahasrotodushti and Atipravritti of mootra. This case study discusses the effect of Mootramarga uttarabasti in reducing the signs and symptoms of neurogenic urinary incontinence and thereby improving the quality of life. A 66 year old male patient was admitted with weakness in left upper and lower limbs, slurred speech, and difficulty in controlling micturition since 5 months. He was a diagnosed case of stroke on the basis of a brain computed tomography scan. During the course of management, Uttarabasti was administered for 8 days with Dhanwantarataila and Balamoolakashaya alternatively. The intervention resulted in reducing the symptoms of neurogenic urinary incontinence as evidenced by the reduction in ICIQ-UI -SF score. It was observed that the overall impact of the disease was reduced and quality of life improved with the help of King’s Health Questionnaire (KHQ).

Unilateral upper and lower limb ischemia mimics stroke: a case report

BackgroundAlthough stroke and acute limb ischemia seem easily distinguishable by anamnesis and physical examination, symptoms may overlap and sometimes mislead the examiner. Such a situation can arise in the occurrence of unilateral neurological symptoms affecting the upper and lower limbs at the same time. As timely diagnosis and a correct therapeutic intervention are crucial to prevent irreversible damage in both diseases, knowledge of the possibility of one disease mimicking the other is essential. We present a unique case of acute unilateral upper and lower limb ischemia mimicking an acute stroke.Case presentationA 69-year-old Caucasian patient with known atherosclerotic risk factors was admitted to the emergency department with a suspected stroke with unilateral paresthesia. After a comprehensive examination of the patient with the need for repeated reevaluation and a negative brain computed tomography scan, acute left-sided upper and lower limb ischemia was eventually diagnosed. The patient underwent surgical revascularization of the upper and lower limbs with a satisfactory result and was discharged from the hospital after a few days.ConclusionIt is of utmost importance to always stay alert for stroke mimics, as overlooking can lead to severe complications and delay adequate therapy. Our case shows that persistent diagnostic effort leads to successful treatment of the patient even on rare occasions, as is the acute unilateral upper and lower limb ischemia.

The Adelaide Facial Bone Rule: A simple prediction model and clinical guideline for the presence of facial fractures using CT brain scans in victims of minor trauma

BackgroundFacial fractures bleed, resulting in high-density fluid in the sinuses (haemosinus) on computed tomography (CT) scans. A CT brain scan includes most maxillary sinuses in the scan field, which should allow detection of haemosinus as an indirect indicator of a facial fracture without the need for an additional CT facial bone scan, yet no robust evidence for this exists in the literature. The aim of this study was to determine whether the presence of haemosinus on a CT brain scan, alone or in combination with other clinical information, can predict the presence of facial fractures. Methods1231 adult patients, who had both brain and facial CT scans performed on the same day, were selected from a seven year period. Patients were eligible if scans were requested for trauma. Brain and facial scans were reviewed separately for the presence of facial fractures, haemosinus, emphysema and intra-cranial haemorrhage. Prediction modelling was used to assess whether findings from brain scans could be used to identify patients requiring further CT scanning. FindingsThe full prediction model included four predictors and showed excellent discrimination (AUROC 0.982; 95 % CI 0.971 – 0.993). A simplified model, more suitable for clinical implementation, used only facial fractures and haemosinus as predictors. This model showed only marginally poorer discrimination (AUROC 0.964; 95 % CI 0.945 – 0.983) and excellent performance on other measures. ConclusionBased on the excellent performance of the simplified prediction model, we present the Adelaide Facial Bone Rule: The absence of blood in the sinuses or facial fractures on a CT brain scan means a CT facial bone scan does not need to be routinely performed in the setting of clinically-determined minor trauma.

Feasibility study on the clinical application of CT-based synthetic brain T1-weighted MRI: comparison with conventional T1-weighted MRI.

This study aimed to examine the equivalence of computed tomography (CT)-based synthetic T1-weighted imaging (T1WI) to conventional T1WI for the quantitative assessment of brain morphology. This prospective study examined 35 adult patients undergoing brain magnetic resonance imaging (MRI) and CT scans. An image synthesis method based on a deep learning model was used to generate synthetic T1WI (sT1WI) from CT data. Two senior radiologists used sT1WI and conventional T1WI on separate occasions to independently measure clinically relevant brain morphological parameters. The reliability and consistency between conventional and synthetic T1WI were assessed using statistical consistency checks, comprising intra-reader, inter-reader, and inter-method agreement. The intra-reader, inter-reader, and inter-method reliability and variability mostly exhibited the desired performance, except for several poor agreements due to measurement differences between the radiologists. All the measurements of sT1WI were equivalent to that of T1WI at 5% equivalent intervals. This study demonstrated the equivalence of CT-based sT1WI to conventional T1WI for quantitatively assessing brain morphology, thereby providing more information on imaging diagnosis with a single CT scan. Real-time synthesis of MR images from CT scans reduces the time required to acquire MR signals, improving the efficiency of the treatment planning system and providing benefits in the clinical diagnosis of patients with contraindications such as presence of metal implants or claustrophobia. • Deep learning-based image synthesis methods generate synthetic T1-weighted imaging from CT scans. • The equivalence of synthetic T1-weighted imaging and conventional MRI for quantitative brain assessment was investigated. • Synthetic T1-weighted imaging can provide more information per scan and be used in preoperative diagnosis and radiotherapy.

Determining the effect of hypertension and diabetes following stroke in tertiary hospital, Aljouf, Saudi Arabia.

Background: Stroke is a common neurological disorder with a high prevalence. The aim of this study was to determine the risk factor, prevalence, and association of types of strokes among diabetes and hypertension patients.&#x0D; Methods: A retrospective study was conducted in King Abdul Aziz, Qurayyat, Sakaka, and Tubarjal hospitals among stroke patients including both sexes within the age &gt; 40 years. Type of stroke was identified by brain computed tomography scans or magnetic resonance imaging and risk factors for stroke and other details were noted on a checklist.&#x0D; Results: Out of 226 stroke patients considered for the present study, in which 48% were males and 52% were females. All lived in the Aljouf region. Most of the patients had risk factors which included Hypertension 49 (21.68%), Diabetes Mellitus 44 (19.46%), Combined (Hypertension and diabetes) 111 (49.11%), and Hyperlipidemia 22 (9.75%). Stroke patients &gt; 60 years of age group showed a higher prevalence of ischemic stroke (p=0.001). The combined risk factor group also showed more prevalence of ischemic stroke (49.11%).&#x0D; Conclusion: Patient having both risk factor Hypertension and diabetes mellitus were major association with ischemic stroke. Majority of the patients with ischemic stroke age at onset &gt; 60 year and irrespectively affected both males and females were equally.&#x0D; Bangladesh Journal of Medical Science Vol. 23 No. 01 January’24 Page : 171-178

Motion Artifact Mimics Subdural Hemorrhage on CT Scans: A Case Series

The aim of this paper is to show a common phenomenon seen in brain computed tomography scans. This phenomenon is seen when the patient slightly moves during the brain scan which creates a motion artifact that appears like pathology and the radiologists might misdiagnose the case as a false positive case. A slight motion artifact appeared as a subdural hemorrhage in five cases. Some of these cases came to the hospital as road traffic accident cases, while others have only suffered a chronic headache. In this case series, five cases are presented, scanned again to rule out any pathology, and these cases are discussed in this paper to find any common pattern among these cases.

Successful Surgical Resection of an Ependymal Cyst in the Fourth Ventricle of a Dog.

Ependymal cysts represent congenital brain malformations rarely described in human medicine, where surgical resection is the treatment of choice. In veterinary medicine, only three cases have been previously reported, with one partially resected with surgery. A 6 yr old entire male American Staffordshire terrier was referred with a 4 mo history of incoordination and collapsing episodes with extensor rigidity. Neurological examination localized the lesion to the left central vestibular system and cerebellum. A brain computed tomography scan showed a hypoattenuating lesion with peripheral contrast enhancement in the fourth ventricle consistent with a cyst and secondary hydrocephalus. Treatment with prednisone was initiated, but despite an initial improvement, neurologic signs recurred and a suboccipital craniectomy to remove the cyst was performed. The cyst was first drained, and the capsule was carefully resected. The histopathological evaluation revealed a simple cubic to cylindrical epithelium with apical cilia and loose surrounding fibrillar tissue consistent with an intraventricular ependymal cyst. Four and a half years after surgery, the dog only shows short episodes of balance loss when turning abruptly but is otherwise neurologically normal. To the authors' knowledge, this is the first reported ependymal cyst in the fourth ventricle of a dog with successful surgical resection.