Head CT Scan Research Articles

Predicting vasospasm risk using first presentation aneurysmal subarachnoid hemorrhage volume: A semi-automated CT image segmentation analysis using ITK-SNAP.

Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) is a significant complication associated with poor neurological outcomes. We present a novel, semi-automated pipeline, implemented in the open-source medical imaging analysis software ITK-SNAP, to segment subarachnoid blood volume from initial CT head (CTH) scans and use this to predict future radiological vasospasm. 42 patients were admitted between February 2020 and December 2021 to our tertiary neurosciences center, and whose initial referral CTH scan was used for this retrospective cohort study. Blood load was segmented using a semi-automated random forest classifier and active contour evolution implemented in ITK-SNAP. Clinical data were extracted from electronic healthcare records in order to fit models aimed at predicting radiological vasospasm risk. Semi-automated segmentations demonstrated excellent agreement with manual, expert-derived volumes (mean Dice coefficient = 0.92). Total normalized blood volume, extracted from CTH images at first presentation, was significantly associated with greater odds of later radiological vasospasm, increasing by approximately 7% for each additional cm3 of blood (OR = 1.069, 95% CI: 1.021-1.120; p < .005). Greater blood volume was also significantly associated with vasospasm of a higher Lindegaard ratio, of longer duration, and a greater number of discrete episodes. Total blood volume predicted radiological vasospasm with a greater accuracy as compared to the modified Fisher scale (AUC = 0.86 vs 0.70), and was of independent predictive value. Semi-automated methods provide a plausible pipeline for the segmentation of blood from CT head images in aSAH, and total blood volume is a robust, extendable predictor of radiological vasospasm, outperforming the modified Fisher scale. Greater subarachnoid blood volume significantly increases the odds of subsequent vasospasm, its time course and its severity.

Adherence to the Canadian CT Head Rule in a Nova Scotian Emergency and Trauma Center.

Background and aims Choosing Wisely Nova Scotia (CWNS), an affiliate of Choosing Wisely Canada (CWC), aims to address unnecessary care and tests through literature-informed lists developed by various disciplines. CWC has identified unnecessary head CTs among the top five tests, procedures, and treatments to question within the emergency department setting. The Canadian CT-scan Head Rule (CCHR) has been found to be the most effective clinical decision rule in adults with minor head injuries. This study aimed to better understand the current status of CCHR use in Nova Scotia, we conducted a retrospective audit of patient charts at the Charles V. Keating Emergency and Trauma Center in Halifax, Nova Scotia. Materials and methods Our mixed methods design included a narrative literature review, a retrospective chart audit, and a qualitative audit-feedback component with physicians who work in the emergency department (ED). The chart audit applied the guidelines for adherence to the CCHR and reported on the level of compliance within the ED. Results Analysis of qualitative data is included here, in parallel with in-depth analysis to contextualize findings from the chart audit. A total of 302 charts of patients presenting to the surveyed site were retrospectively reviewed for this study. Of the 37 cases where the CT head was indicated as per the CCHR, a CT was ordered 32 (86.5%) times. Of the 176 cases where a CT head was not indicated as per the CCHR, a CT was not ordered 155 (88.1%) times. Therefore, the CCHR was followed in 187 (87.8%) of the total 213 cases where the CCHR should be applied. Conclusions Our review revealed that the CCHR was adhered in 87.8% of cases at the surveyed ED. Identifying contextual factors that facilitate or hinder the application of CCHR in practice is critical to achieving the goal of reducing unnecessary CTs. This work will be presented to the physician group to engage and understand factors that are enablers in the process of ED minor head injury care.

P458 AN UNUSUAL REINDEER–IS LEFT VENTRICULAR MASS

Abstract A 90–year–old woman is brought to the closest emergency room after being found in a confusional state of mind, with lateral–sided sight deviation with normal cardiovascular findings. Her past medical history is characterized by the presence of systemic hypertension, moderate–to–severe chronic disease. The 12–lead electrocardiogram showed sinus rhythm and aspecific anomalies of the left ventricular repolarization. Lab tests showed normal white blood cells count with increased creatinine levels and quite normal flogosis indices. An initial transthoracic echocardiogram (TTE) showed mild left ventricular concentric hypertrophy with preserved systolic function, but also revealed the presence of a moving posterior mitral leaflet mass, determining mild mitral regurgitation. A head CT scan was performed, showing a right temporo–insular ischemic ipodensity. Considering the echocardiographic and neuronal findings, a transesophageal echocardiogram (TEE) was indicated to look for and better describe the suspicious mass, after beginning an antibiotic therapy in an empiric regimen. TEE revelead a multi–lobular mass characterized by inhomogeneous echogenicity, leaning on the annulus and the atrial side of the posterior mitral leaflet that was fissurated, leading to mild mitral regurgitation. The left appendage showed normal emptying velocity and absence of thrombi. It was not easy to describe this mass morphology and dimensions, but in some projections, it reminded us of a reindeer with various antlers. This case could resemble a classic mitral valve endocarditis, evolved into valve fissuration and arterial embolization leading to ischemic stroke, but the unusual fact is that the laboratory tests showed no white blood cells alteration during the whole hospitalization, with a really minimal CRP change and always negative procalcitonin. That is why we came into the idea that such a mass could also not represent a classical endocarditis. Considering that the echocardiographic characteristics of a thrombus were not encountered, the mass may be a tumor. The most frequent tumors involving the heart valves are papillary fibroelastomas. Considering the absence of clinic endocarditis, some hints led to consider this differential diagnosis: fibroelastomas mostly occur during older ages, they frequently have a mitral or aortic location and they can embolize, differently from vegetations, they are located mostly on the annulus and the basal posterior mitral leaflet.

Cryptococcal meningoencephalitis in an immunodeficiency virus positive patient coinfected with tuberculosis

Background: Cryptococcal meningitis is an inflammation of the meninges due to Cryptococcus fungal infection which commonly invades people living with immunodeficiency virus (PLHIV) with impaired immunity. The disease has a high mortality rate and is frequently misdiagnosed in the early stages due to vague symptoms. This case report aimed to provide information regarding diagnosing and managing cryptococcal meningoencephalitis in patients with acquired immunodeficiency syndrome (AIDS) and tuberculosis. Case presentation: We reported a case of 34-year-old woman that complained of headache and fever from one month ago. There were also oral white patches in the last two weeks. The patient was diagnosed with lung TB and human immunodeficiency virus (HIV) in February 2021, but the TB was just being treated in the past two months and HIV in last two weeks. Head CT-scan with contrast showed meningoencephalitis, brain edema, left frontal, left ethmoidal, left and right maxillary and left sphenoid sinusitis. On the 9th day of hospitalization, the patient had seizures. Analysis of the cerebrospinal fluid culture revealed Cryptococcus neoformans. The patient’s comorbidities were leucopenia, hypoalbuminemia, pneumonia, brain edema which led to poor prognosis. On the 10th day, the seizures relapsed, followed by the drastically reduced SpO2 and death. Septic shock and multiorgan failure were considered the cause of the case's death. Conclusion: This case highlights the importance of early diagnosis and management to avoid unfavorable outcome.

Pott Puffy Tumor : Case Report

Pott puffy tumor (PPT) is an abscess of the subperiosteal os, frontalis. Frontalis subperiosteal abscess is often found in cranial osteomyelitis. Cranial osteomyelitis is an inflammatory process of the cranial bones, mainly caused by pyogenic organisms. The most common cause of cranial osteomyelitis in developing countries is paranasal sinusitis. One of the causes of PPT is an infection of the frontal sinus. Intracranial complications are the most common complications of PPT, one of which is a cerebral abscess in the frontal lobe. In this case report, the patient complained of forehead swelling that spread to both upper eyelids. There is a history of boils on the left side of the forehead since 3 weeks ago but was not treated medically. On physical examination, there was no neurological deficit. In the initial action, aspiration of the swelling results in the form of pus. Based on the results of a plain head CT scan and 3D skull bones, the results obtained were an appearance of an abscess in the subperiosteal frontal bone and osteomyelitis of the frontal bone. The patient underwent debridement craniectomy and further therapy in the form of intravenous antibiotics. As a follow-up examination, an examination of pus culture and examination of anatomical pathology were carried out, and obtained cranial osteomyelitis results but found no pathogenic germs.

Abstract #1411935: A Radiographic Diagnosis: IgG4-Related Hypophysitis Presenting with Hypopituitarism and Central Diabetes Insipidus

Hypophysitis is defined as inflammation of the pituitary gland. IgG4-related hypophysitis is a rare form and isolated IgG4-related hypophysitis is even more rare. Here, we discuss an interesting patient who presented with symptoms of diabetes insipidus and was found to have panhypopituitarism with suspicious MRI findings of a suprasellar mass and a thickened pituitary stalk, suggestive of IgG4-related hypophysitis. A 69-year-old male with past medical history of lung adenocarcinoma status-post right pneumonectomy, chronic obstructive pulmonary disease, orthostatic hypotension, and poor oral intake due to esophageal compression presented with acute encephalopathy and sepsis secondary to pneumonia. CT head scan done for encephalopathy showed a 1.2 cm suprasellar mass. On consultation, the patient was found to be hypernatremic. Upon further questioning, the patient reported experiencing polydipsia, nocturia, chronic cold intolerance, fatigue, and impotence for several weeks to months. He denied any vision changes, breast tenderness, or galactorrhea. Laboratory testing revealed a sodium level of 157 mmol/L (n.135-145 mmol/L) with plasma osmolality elevated at 332 mOsm/kg (n.275-295 mosm/kg). Urine sodium was low at < 20 mmol/L. Desmopressin (DDAVP) 0.1mg nightly was started given concern for diabetes insipidus. Peak cortisol after performed Cosyntropin stimulation test resulted at 13.5mcg/dL with an ACTH 6 pg/mL (n.6-50 pg/mL). TSH was < 0.01 mU/L, free T4 1.79 ng/dL, and free T3 4.9 nmol/L. The elevated free T3 was felt to be from heparin displacement. Total testosterone was 84 ng/dL with suppressed FSH and LH. Elevated prolactin of 39 ng/mL was thought to be from stalk-effect. MRI of the pituitary gland revealed a 1.3cm enhancing suprasellar mass in the region of the optic chiasm and a smaller 9mm intra-sellar mass, with a thickened pituitary stalk. Given these radiologic findings and the patient's age and gender, the possibility of IgG4 hypophysitis was suspected. CT chest, abdomen, and pelvis were unremarkable. In addition to the DDAVP, he was started on high-dose hydrocortisone, thyroxine replacement, and testosterone replacement. Serum IgG4 level was 23.6 mg/dL (n. 4-86 mg/dL). A six week repeat pituitary MRI is pending; however, the patient is clinically improving and doing well. Specific radiologic findings, such as thickened pituitary stalk and pituitary enlargement with suprasellar mass, led us to strongly consider IgG4-related hypophysitis in our differential for this patient. Clinical presentation of panhypopituitarism, along with patient age and gender, also supported the diagnosis of IgG4-related hypophysitis. Although this patient does not meet all Leporati diagnostic criteria for IgG4-related hypophysitis, the high degree of suspicion led to prompt treatment with high dose steroids. High dose steroids have been shown to revert symptoms and prevent irreversible fibrosis. This case highlights the need for radiologists and endocrinologists to work together in the early recognition of the diagnosis and treatment of IgG4-related hypophysitis.

Evaluation of normal measurements of fourth ventricle by computed tomography

Background: Size of fourth ventricle varies in different pathologies, in the context of enlarged brain ventricles size observed in routine clinical practices, knowledge of the usual range of exact measurement is required. Aims and Objectives: This study is hospital-based observational study to derive normal measurement range of fourth ventricle and correlating it with measurements of cerebrum and age of patients. Materials and Methods: Hospital-based prospective study was conducted in the department of radiodiagnosis in a teaching medical college. Patients with virtually normal study on unenhanced head CT scan of both sex and age groups from 2 year to 60 years, were included in the study. Patients with CT scans showing gross pathological changes affecting the normal anatomy of ventricles were excluded from the study. Results: The mean age of the cases was 37.0±16.88 years. Mean fourth ventricle anterioposterior dimension is 7.5±2.5 mm and transverse dimension is 12±3.1 mm. Anteroposterior diameter of fourth ventricle showed non-significant correlation (r=0.06, P=0.56) with anteroposterior diameter of skull and no significant correlation with (r=0.07, P=0.45) transverse diameter (TD) of skull. AP diameter of fourth ventricle showed a positive correlation with age, which was statistically significant (r2=0.698, P=0.01). TD of fourth ventricle showed slight positive correlation (r=0.202 P=0.048) with anteroposterior diameter of skull and (r=0.142, P=0.168) TD of skull whereas nil with. TD of fourth ventricle showed a positive correlation with age, which was statistically non-significant (r2=0.659, P=0.01). It increases with age. Conclusion: Knowledge of normal measurements helps in assessing, dilated fourth ventricle in various pathologies.

Nontraumatic spontaneous bilateral intracerebral haemorrhage in a young patient: a rare case report.

Twenty-three-year-old male with no prior comorbidities presented to emergency with sudden onset loss of consciousness and 1 episode of seizure. No history of intoxication or trauma was given. Glasgow Coma Scale at presentation was E1V2M2. CT scan head revealed bilateral basal ganglia haematoma along intraventricular haemorrhage. The patient was managed conservatively in the Neurosurgical Intensive care unit. Supportive management was provided. The patient's motor response was improving and a repeat CT scan showed a resolving haematoma. However, due to poor economic conditions, the patient party left against medical advice. Spontaneous bilateral basal ganglia haemorrhage is a rare surgical emergency with no clear consensus on a management approach. This case highlights the importance of undiagnosed hypertension in causing intracerebral haemorrhage in poor economic groups.

D-dimer correlation as a marker of coagulopathy with neuroimaging abnormalities on head CT scans of COVID-19 patients

Background: COVID-19 is a coronavirus disease with the main symptoms in the respiratory tract which can cause hypoxia. The duration and severity of the hypoxia can lead to oxidative stress that can affect the brain. The phenomenon of thromboembolism was also found in the form of an increase in coagulopathy markers which can cause abnormalities in small blood vessels in various organs, including the brain. Methods: We conducted a prospective crossectional study of 23 samples that met the inclusion criteria. Duration of hypoxia, degree of hypoxia based on oxygen saturation, and D-Dimer level as independent variables underwent Spearman correlation test with neuroimaging abnormalities on head CT scan. Results: The sample population consisted of 14 men (60.90%) and 9 women (39.10%), with the highest age group being 61 – 80 years old (56.50%) who underwent a head CT scan without contrast administration. Eighteen samples were found to have brain infarction, while 5 samples were without abnormalities. The Spearman correlation test found a correlation (p=0.003) with moderate correlation (r=0.558) between the D-Dimer level as a coagulopathy marker and abnormal findings on the head CT scan of samples. Where 15 samples with high D-Dimer levels (D-Dimer values above the normal level) and 3 samples with normal D-Dimer levels were found to have brain infarction. Meanwhile, the duration and degree of hypoxia based on the oxygen saturation value did not show a significant correlation with neuroimaging abnormalities (p&gt;0.05). Conclusion: There was a moderate correlation between the D-Dimer value. No significant correlation was found between the duration of hypoxia and the degree of oxygen saturation toward neuroimaging abnormalities in COVID-19 patients.

Non-motor seizure diagnosed after mild traumatic brain injury: a case report

Introduction: In 10% of head injury cases, nonmotor seizures were detected by electroencephalography (EEG) performed in the acute phase. Nonmotor seizures are often not diagnosed at the start of treatment because the symptoms are often not recognized by the patient's family or doctor. The incidence of seizures in patients with minor head injuries is very low. From the literature, it was found that the type and severity of the head injury is a significant factors in the incidence of post-traumatic seizure. Thus, in this article, we report a case of nonmotor seizures in a patient after a minor head injury. Case description: An Indonesian female, 53 years old, complained of sudden silence when speaking after 4 days earlier, she fell and hit her head on the right side. There was no loss of consciousness, headache, vomiting or limb weakness. Complaints of motor seizures and a history of previous seizures were denied. There were no cranium defects, hematomas, or open wounds on examination. The results of laboratory tests and non-contrast head CT scans were expected. On electroencephalography (EEG) examination, epileptiform waves were found in the left temporal region. The patient was given anti-seizure drugs, and complaints improved within 2 days of therapy. It is crucial to carry out an EEG examination in the acute phase of a head injury to exclude the possibility of nonmotor seizures and brain dysfunction, which will be at risk of causing seizures later in life after trauma. Conclusion: EEG examination in the acute phase of head injury is used to exclude the possibility of nonmotor seizures and brain dysfunction, which will be at risk of causing seizures later in life after trauma.

Cerebral Hemorrhage with Edema in A Five-Week-Old: A Case of Late-Onset Vitamin K Deficiency Bleeding, Rare Diagnosis in Resource-Limited Settings

Introduction: Vitamin K deficiency bleeding (VKDB) is a term that describes the condition of hemorrhagic disorders in newborns. Late-onset VKDB occurs between the second week and sixth month of life. Intracranial hemorrhage often occurs in cases of late-onset VKDB and can cause 14-20% mortality and 40% long-term neurological morbidity, so it is important to treat patients until they are stable, especially with limited health facilities. Case Report: A baby boy aged 1 month 8 days was brought by his parents to RSUD Deli Serdang Lubuk Pakam with the chief complaint of an enlarged stomach, accompanied by paleness, weakness, convulsions, and altered consciousness. A midwife assisted the delivery with unknown history of immediate vitamin K injection after birth. We diagnosed the patient with VKDB according to the clinical symptoms. The head CT scan showed subdural and subarachnoid hemorrhage with cerebral edema. We transfused the patient with Packed Red Cells and Fresh Frozen Plasma 20 cc/12 hours 5 times, administered Vitamin K injection 3 mg/IM for 3 days, and other supportive therapy. The patient's condition improved within the third day of hospitalization with recovered consciousness and was transferred to the referral hospital. Discussion: The key feature of late-onset VKDB is the incidence of ICH in 30-88% of patients, leading to a high incidence of mortality. This study highlights the importance of prompt, and early treatment of VKDB with proper history taking, clinical examination, and relevant investigations to reduce morbidity and mortality. Conclusion: In conclusion, secondary late-onset PDVC is more common than the primary subtype, and late-onset PDVC is still an important cause of morbidity and mortality in developing countries including Indonesia, where vitamin K prophylaxis is not routinely performed

Rapidly progressive cerebral atrophy following a posterior cranial fossa stroke: Assessment with semiautomatic CT volumetry.

The effect of posterior cranial fossa stroke on changes in cerebral volume is not known. We assessed cerebral volume changes in patients with acute posterior fossa stroke using CT scans, and looked for risk factors for cerebral atrophy. Patients with cerebellar or brainstem hemorrhage/infarction admitted to the ICU, and who underwent at least two subsequent inpatient head CT scans during hospitalization were included (n = 60). The cerebral volume was estimated using an automatic segmentation method. Patients with cerebral volume reduction > 0% from the first to the last scan were defined as the "cerebral atrophy group (n = 47)," and those with ≤ 0% were defined as the "no cerebral atrophy group (n = 13)." The cerebral atrophy group showed a significant decrease in cerebral volume (first CT scan: 0.974 ± 0.109 L vs. last CT scan: 0.927 ± 0.104 L, P < 0.001). The mean percentage change in cerebral volume between CT scans in the cerebral atrophy group was -4.7%, equivalent to a cerebral volume of 46.8 cm3, over a median of 17days. The proportions of cases with a history of hypertension, diabetes mellitus, and median time on mechanical ventilation were significantly higher in the cerebral atrophy group than in the no cerebral atrophy group. Many ICU patients with posterior cranial fossa stroke showed signs of cerebral atrophy. Those with rapidly progressive cerebral atrophy were more likely to have a history of hypertension or diabetes mellitus and required prolonged ventilation.

Fentanyl Overdose Presented with Unconsciousness, Hypoxia, Hypotension and Pinpoint Pupil Complicated by Acute Kidney Injury and Right Hemiparesis: A Rare Case Report

A 25-years-old -male was found unconscious with empty fentanyl ampule; slow breathing with central cyanosis; SaO2 85% on air; blood pressure 90/50 mmHg, pulse rate 100/minutes; respiratory rate 12/minutes; central cyanosis; crackles in both lungs; multiple venipuncture marks in his left forearm and pinpoint pupil. He was treated as fentanyl overdose with intravenous naloxone, fluid therapy, ventilatory support and oxygenation. Right hemiparesis was noted on recovery; CT scan head showed multiple areas of infarction in basal ganglia and cerebral hemisphere. Acute kidney injury recovered with hemodialysis.

Single brain metastasis as onset of stage I endometrial carcinoma in patient affected by multiple sclerosis: the first case in literature

Brain metastases in any gynecological cancer are a rare occurrence. Even more so, it is extremely rare for a gynecological malignancy to manifest itself with symptoms indicative of cerebral involvement. Literature regarding the association between MS and cancer is conflicting. We herein report a rare presentation of single metastasis of endometrial carcinoma in a 59-year-old woman affected by Primary Progressive Multiple Sclerosis (PPMS). A head CT scan was performed, which revealed the presence of an expansive lesion in the left parietal region. After careful assessment, a high-grade endometrial carcinoma was diagnosed and a decision was made to remove both the primary lesion and the brain metastasis in one sitting, through a conjoined surgery session involving neurosurgeons and gynecologists. The postoperative course was free from complications up until a few days after being transferred to a rehabilitation center, where she died following respiratory complications.

Periprocedural Cerebral Air Embolism; A Rare and Potentially Fatal Complication of Watchman Device (P3-5.028)

<h3>Objective:</h3> To study peri-procedural complications of Watchman device placement. <h3>Background:</h3> Left atrial appendage therapy with a Watchman device is a non-inferior ischemic stroke prevention strategy for patients with paroxysmal atrial fibrillation (pAF) deemed to be unsuitable for conventional anticoagulation. Peri-procedural air embolism is a known complication and can present with systemic emboli provoking ischemic strokes, coronary ischemia, or cardiac arrest. The PROTECT AF trial specifically documented 5 peri-procedural strokes out of 542 total procedures due to air embolism. We present two cases of periprocedural cerebral emboli resulting in potentially fatal complications. <h3>Design/Methods:</h3> Retrospective review of electronic medical records. <h3>Results:</h3> 81year old gentleman was noted to have acute change of decreased generalized responsiveness, and concomitant electrocardiographic change during Watchman deployment. Rapid reversal of anesthetic agents did not result in clinical improvement. Neurological exam showed asymmetric pupils, L&gt;R, and initially withdrew on all four extremities with rapid progression to flexor posturing to noxious stimulus. CT stroke protocol demonstrated an area of acute infarction in the right middle cerebral artery territory, associated with air in sulci. He required transfer to another facility for hyperbaric oxygen treatment. Follow up CT scan of head demonstrated complete resolution of air emboli, however his neurologic exam remained poor, and patient expired during hospital admission. <h3>Case 2:</h3> 61year old gentleman presented with periprocedural acute onset of right gaze deviation, left facial droop, left sided paralysis, sustained clonus, and left sensory deficit. CT stroke protocol showed hypodensity in the right MCA territory with air in sulci. He was transferred for hyperbaric oxygen therapy. After protracted rehabilitation, he lives independently with residual left sided weakness. <h3>Conclusions:</h3> Air embolism remains an under-recognized potentially fatal complication of Watchman device placement. These cases indicate the need to recognize air emboli as an etiology of periprocedural stroke requiring a unique treatment strategy including a framework for expedited hyperbaric access. <b>Disclosure:</b> Dr. Peshwe has nothing to disclose. Dr. Munir has nothing to disclose. Dr. Hatfield has nothing to disclose. The institution of an immediate family member of Dr. Adcock has received research support from NIH.

Teaching Neuro Images : Multicompartmental intracranial hemorrhage in a pediatric patient

A previously healthy 9-year-old girl presented with sudden-onset headache followed by confusion. In the emergency department, she was hypertensive, bradycardic, and no longer responsive to any stimuli. An emergent head CT scan demonstrated a left frontal intraparenchymal hematoma with intraventricular and subarachnoid extension as well as subfalcine herniation (figure). She underwent decompressive hemicraniectomy, and digital subtraction angiography confirmed a 7-mm left middle cerebral artery aneurysm (figure).

Application of artificial intelligence centric workflows for evaluation of neuroradiology emergencies

The goal of this study was to perform a pilot study to assess user-interface of radiologists with an artificial-intelligence (AI) centric workflow for detection of intracranial hemorrhage (ICH) and cervical spine fractures (CSFX). Over 12-month period, interaction and usage of AI software implemented in our institution, Aidoc, on head and cervical spine CT scans were obtained. Several interaction variables were defined, assessing different types of interaction between readers of different training level and AI software. The median usage of AI-centric workflow for detection of ICH and CSFX were 28.8% and 21.8%, respectively, demonstrating a significant additional engagement beyond Native workflow (worklist and PACS). Further studies are warranted to expand interaction assessments to further understand the value unlocked by the AI-centric workflows.

Monitoring Pediatric Head CT Scan Dose Levels: A Retrospective Study of Diagnostic Reference Levels in a Single Hospital in Abu Dhabi, UAE

Diagnostic reference levels (DRLs) are critical operational standards for monitoring radiological imaging parameters and ensuring patient safety in hospitals. A regular review of DRLs is necessary to optimize scanners and protocol parameters. This retrospective study collected data on the CT dose index volume and dose–length product for 250 children who underwent head CT scans in the region of Abu Dhabi, United Arab Emirates. Descriptive statistics were used to present median, range, and interquartile range values for each pediatric age group, based on region and protocol. The 75th percentile was used as the reference point for local DRLs. Proposed values of DRLs were suggested per age groups; 304 mGy∙cm (children &lt; 1 year), 385 mGy∙cm (children ≥ 1 year to &lt;5 years), 441 mGy∙cm (children ≥ 5 years to &lt;10 years), and 568 mGy∙cm (patients ≥ 10 years to &lt;16 years. A comparison of the local DRLs with previously established ones was carried out, and differences were discussed. To the best of our knowledge, this is the first study on pediatric head CT scans in this region. We believe the results can be used as a baseline for establishing local DRLs in the Emirate of Abu Dhabi and national DRLs in the United Arab Emirates.

Hypernatremic hemorrhagic encephalopathy as an unexpected critical complication in children: a case report from a tertiary hospital

Introduction: Hypernatremic hemorrhagic encephalopathy (HHE) is one of the complications of hypernatremic dehydration which is relatively uncommon in patients with hypernatremia. Severe hypernatremia might lead to brain shrinkage resulting in intracranial bleeding which can increase morbidity and mortality, especially in children. Hypernatremic hemorrhagic encephalopathy is harmful, but only limited cases are reported. This case highlights the role of cautious management of hypernatremic dehydration and the need for intense monitoring due to the unexpected complication of HHE. Case presentation: A 4 months old female infant presented with a decreased consciousness. She showed signs of shock along with acute diarrhoea and severe dehydration. Laboratory findings revealed severe hypernatremia and high septic marker. Rehydration and correction of hypernatremia were done, but during the process, several episodes of general tonic-clonic seizure occurred. A Head CT scan was done and showed subdural hemorrhage in the posterior interhemispheric fissure and intraventricular hemorrhage in the posterior horn of the right lateral ventricle. Conservative management was undertaken and the patient was clinically improved progressively. On the 11th day of hospitalization, the patient's condition had been significantly improved without neurological sequelae and was later discharged on the 11th day of hospitalization. Conclusion: Close monitoring of clinical, neurological, and laboratory examination is essential in the management of hypernatremic dehydration due to the possibility of HHE, even when on the right procedure. Once neurological complication is suspected, an immediate imaging study should be performed and modifying therapy is required.

Frequency and clinical features of radiographic head injury caused by inpatient falls: a single-centre retrospective cohort study

ObjectivesThe lack of clear criteria makes it difficult for clinicians to determine which patients should be imaged after an inpatient fall. This study identified the clinical characteristics of patients who...