Normal Cranial Computed Tomography Scan Research Articles

An Early Warning System Using Machine Learning for the Detection of Intracranial Hematomas in the Emergency Trauma Setting.

To present an early warning system (EWS) that employs a supervised machine learning algorithm for the rapid detection of extra-axial hematomas (EAHs) in an emergency trauma setting. A total of 150 sets of cranial computed tomography (CT) scans were used in this study with a total of 11,025 images. Of the CTs, 75 were labeled as EAH, the remaining 75 were normal. A random forest algorithm was utilized for the detection of EAHs. The CTs were randomized into two groups: 100 samples for training of the algorithm (split evenly between EAH and normal cases), and 50 samples for testing. In the training phase, the algorithm scanned every CT slice separately for image features such as entropy, moment, and variance. If the algorithm determined an EAH on two or more images in a CT set, then the workflow produced an alert in the form of an email. Data from 50 patients (25 EAH and 25 controls) were used for testing the EWS. For all CTs with an EAH, an alert was produced, with a 0% false-negative rate. For 16% of the cases, the practitioner received an email from the EWS that the patient might have an EAH despite having a normal CT scan. Positive and negative predictive values were 86% and 100%, respectively. An EWS based on a machine learning algorithm is an efficient and inexpensive way of facilitating the work of emergency practitioners such as emergency physicians, neuroradiologists, and neurosurgeons.

Immediate and Delayed Traumatic Intracranial Hemorrhage in Patients With Head Trauma and Preinjury Warfarin or Clopidogrel Use

Patients receiving warfarin or clopidogrel are considered at increased risk for traumatic intracranial hemorrhage after blunt head trauma. The prevalence of immediate traumatic intracranial hemorrhage and the cumulative incidence of delayed traumatic intracranial hemorrhage in these patients, however, are unknown. The objective of this study is to address these gaps in knowledge. A prospective, observational study at 2 trauma centers and 4 community hospitals enrolled emergency department (ED) patients with blunt head trauma and preinjury warfarin or clopidogrel use from April 2009 through January 2011. Patients were followed for 2 weeks. The prevalence of immediate traumatic intracranial hemorrhage and the cumulative incidence of delayed traumatic intracranial hemorrhage were calculated from patients who received initial cranial computed tomography (CT) in the ED. Delayed traumatic intracranial hemorrhage was defined as traumatic intracranial hemorrhage within 2 weeks after an initially normal CT scan result and in the absence of repeated head trauma. A total of 1,064 patients were enrolled (768 warfarin patients [72.2%] and 296 clopidogrel patients [27.8%]). There were 364 patients (34.2%) from Level I or II trauma centers and 700 patients (65.8%) from community hospitals. One thousand patients received a cranial CT scan in the ED. Both warfarin and clopidogrel groups had similar demographic and clinical characteristics, although concomitant aspirin use was more prevalent among patients receiving clopidogrel. The prevalence of immediate traumatic intracranial hemorrhage was higher in patients receiving clopidogrel (33/276, 12.0%; 95% confidence interval [CI] 8.4% to 16.4%) than patients receiving warfarin (37/724, 5.1%; 95% CI 3.6% to 7.0%), relative risk 2.31 (95% CI 1.48 to 3.63). Delayed traumatic intracranial hemorrhage was identified in 4 of 687 (0.6%; 95% CI 0.2% to 1.5%) patients receiving warfarin and 0 of 243 (0%; 95% CI 0% to 1.5%) patients receiving clopidogrel. Although there may be unmeasured confounders that limit intergroup comparison, patients receiving clopidogrel have a significantly higher prevalence of immediate traumatic intracranial hemorrhage compared with patients receiving warfarin. Delayed traumatic intracranial hemorrhage is rare and occurred only in patients receiving warfarin. Discharging patients receiving anticoagulant or antiplatelet medications from the ED after a normal cranial CT scan result is reasonable, but appropriate instructions are required because delayed traumatic intracranial hemorrhage may occur.

Chapter 3. Indications for intracranial pressure monitoring

Chapter 3. Indications for intracranial pressure monitoring

Do Children With Blunt Head Trauma and Normal Cranial Computed Tomography Scan Results Require Hospitalization for Neurologic Observation?

Children evaluated in the emergency department (ED) with minor blunt head trauma, defined by initial Glasgow Coma Scale (GCS) scores of 14 or 15, are frequently hospitalized despite normal cranial computed tomography (CT) scan results. We seek to identify the frequency of neurologic complications in children with minor blunt head trauma and normal ED CT scan results. We conducted a prospective, multicenter observational cohort study of children younger than 18 years with blunt head trauma (including isolated head or multisystem trauma) at 25 centers between 2004 and 2006. In this substudy, we analyzed individuals with initial GCS scores of 14 or 15 who had normal cranial CT scan results during ED evaluation. An abnormal imaging study result was defined by any intracranial hemorrhage, cerebral edema, pneumocephalus, or any skull fracture. Patients with normal CT scan results who were hospitalized were followed to determine neurologic outcomes; those discharged to home from the ED received telephone/mail follow-up to assess for subsequent neuroimaging, neurologic complications, or neurosurgical intervention. Children (13,543) with GCS scores of 14 or 15 and normal ED CT scan results were enrolled, including 12,584 (93%) with GCS scores of 15 and 959 (7%) with GCS scores of 14. Of 13,543 patients, 2,485 (18%) were hospitalized, including 2,107 of 12,584 (17%) with GCS scores of 15 and 378 of 959 (39%) with GCS scores of 14. Of the 11,058 patients discharged home from the ED, successful telephone/mail follow-up was completed for 8,756 (79%), and medical record, continuous quality improvement, and morgue review was performed for the remaining patients. One hundred ninety-seven (2%) children received subsequent CT or magnetic resonance imaging (MRI); 5 (0.05%) had abnormal CT/MRI scan results and none (0%; 95% confidence interval [CI] 0% to 0.03%) received a neurosurgical intervention. Of the 2,485 hospitalized patients, 137 (6%) received subsequent CT or MRI; 16 (0.6%) had abnormal CT/MRI scan results and none (0%; 95% CI 0% to 0.2%) received a neurosurgical intervention. The negative predictive value for neurosurgical intervention for a child with an initial GCS score of 14 or 15 and a normal CT scan result was 100% (95% CI 99.97% to 100%). Children with blunt head trauma and initial ED GCS scores of 14 or 15 and normal cranial CT scan results are at very low risk for subsequent traumatic findings on neuroimaging and extremely low risk of needing neurosurgical intervention. Hospitalization of children with minor head trauma after normal CT scan results for neurologic observation is generally unnecessary.

MR imaging in the detection of diffuse axonal injury with mild traumatic brain injury

Purpose: To evaluate the occurrence and distribution of mild traumatic brain injury (MTBI) caused by diffuse axonal injury (DAI) using magnetic resonance (MR) imaging and to attempt to correlate MR findings with post-concussion symptoms (PCS).Patients and methods: Forty MTBI patients (mean age: 32.5 years) with normal cranial computed tomography (CT) findings were examined with standard MR protocol including T1-weighted, T2-weighted, fluid attenuated inversion recovery (FLAIR), gradient echo (GRE) and diffusion-weighted (DW) sequences. MR imaging was performed within 24 hours of injury. The lesions were classified as DAI based on their location and morphologic appearance.Results: In MR imaging of five (12.5%) of the patients, the lesions compatible with DAI were observed. Four patients (10%) had the foci of low signal intensity compatible with hemorrhagic shear injury on the GRE sequence, and five (12.5%) patients had high signal intensity on FLAIR and DW sequence.Conclusion: MR imaging can be helpful in revealing DAI lesions in patients with normal CT scan findings after MTBI. FLAIR, GRE and DW sequences are superior to conventional spin-echo images in detecting DAI lesions.

Diagnóstico de la hemorragia subaracnoidea espontánea de escasa cuantía o de larga evolución: a propósito de un caso

Subarachnoid hemorrhage implies the presence of blood within the subarachnoid space from some pathologic process. The initial study of choice is an urgent Cranial Computed Tomography scan, but its sensitivity declines with time. So that it is recommended that patients with severe sudden headache but normal Cranial Computed Tomography scan, should have a lumbar puncture performed, more than 12 hours after the onset of symptoms, to rule out subarachnoid hemorrhage. The methods for distinguishing among traumatic lumbar puncture and true Subarachnoid hemorrhage include the erythrocyte level, the "three tube test", D-dimer assay and ferritin in cerebrospinal fluid. But the best technique is the xanthochromia o yellow-to-orange cerebrospinal fluid supernatant, measured spectrographically. We report a case of a young woman with a subarachnoid hemorrhage diagnosed by xanthochromia after 18 days after the onset of bleeding.

Do children require hospitalization after immediate posttraumatic seizures?*1

Study objective We determine whether children with immediate posttraumatic seizures require hospitalization for observation of possible neurologic complications. Methods This was a prospective observational cohort study of children younger than 18 years with blunt head trauma resulting in immediate posttraumatic seizures. Patients were examined by faculty emergency physicians and underwent cranial computed tomography (CT) scanning. Children were divided into 2 cohorts according to the presence or absence of traumatic brain injury on cranial CT scan, with the a priori assumption that children with posttraumatic seizures who have abnormal cranial CT scan results require hospitalization. The outcomes of interest were neurologic complications (including further seizure activity or neurologic deficits) or the necessity for neurosurgical intervention. Medical records of hospitalized patients were reviewed, and patients discharged from the emergency department (ED) were contacted by telephone approximately 1 week after hospital discharge to identify those who developed short-term neurologic complications. Results Sixty-three children with a median age of 7 years (interquartile range 3 to 14 years) had posttraumatic seizures, and all but 1 child underwent cranial CT imaging. Ten (16%; 95% confidence interval [CI] 8% to 27%) patients had traumatic brain injuries on CT scan, and all were hospitalized. Three of these 10 patients underwent craniotomy, and 2 patients had further seizure activity. Fifty-two patients had normal cranial CT scan results, and 20 patients were hospitalized for observation. Telephone follow-up was obtained in 31 of the 32 patients with normal CT scan results who were discharged from the ED. None of the 52 patients (0%; 95% CI 0% to 5.6%) with normal cranial CT scan results had further seizure activity or required neurosurgical interventions. Conclusion Children with normal neurologic examination results and normal cranial CT scan results after immediate posttraumatic seizures are at low risk for further short-term complications that require immediate hospitalization. These children may be considered for discharge home from the ED.

Do children require hospitalization after immediate posttraumatic seizures?

We determine whether children with immediate posttraumatic seizures require hospitalization for observation of possible neurologic complications. This was a prospective observational cohort study of children younger than 18 years with blunt head trauma resulting in immediate posttraumatic seizures. Patients were examined by faculty emergency physicians and underwent cranial computed tomography (CT) scanning. Children were divided into 2 cohorts according to the presence or absence of traumatic brain injury on cranial CT scan, with the a priori assumption that children with posttraumatic seizures who have abnormal cranial CT scan results require hospitalization. The outcomes of interest were neurologic complications (including further seizure activity or neurologic deficits) or the necessity for neurosurgical intervention. Medical records of hospitalized patients were reviewed, and patients discharged from the emergency department (ED) were contacted by telephone approximately 1 week after hospital discharge to identify those who developed short-term neurologic complications. Sixty-three children with a median age of 7 years (interquartile range 3 to 14 years) had posttraumatic seizures, and all but 1 child underwent cranial CT imaging. Ten (16%; 95% confidence interval [CI] 8% to 27%) patients had traumatic brain injuries on CT scan, and all were hospitalized. Three of these 10 patients underwent craniotomy, and 2 patients had further seizure activity. Fifty-two patients had normal cranial CT scan results, and 20 patients were hospitalized for observation. Telephone follow-up was obtained in 31 of the 32 patients with normal CT scan results who were discharged from the ED. None of the 52 patients (0%; 95% CI 0% to 5.6%) with normal cranial CT scan results had further seizure activity or required neurosurgical interventions. Children with normal neurologic examination results and normal cranial CT scan results after immediate posttraumatic seizures are at low risk for further short-term complications that require immediate hospitalization. These children may be considered for discharge home from the ED.

Do children require hospitalization after immediate posttraumatic seizures?

Study objective We determine whether children with immediate posttraumatic seizures require hospitalization for observation of possible neurologic complications. Methods This was a prospective observational cohort study of children younger than 18 years with blunt head trauma resulting in immediate posttraumatic seizures. Patients were examined by faculty emergency physicians and underwent cranial computed tomography (CT) scanning. Children were divided into 2 cohorts according to the presence or absence of traumatic brain injury on cranial CT scan, with the a priori assumption that children with posttraumatic seizures who have abnormal cranial CT scan results require hospitalization. The outcomes of interest were neurologic complications (including further seizure activity or neurologic deficits) or the necessity for neurosurgical intervention. Medical records of hospitalized patients were reviewed, and patients discharged from the emergency department (ED) were contacted by telephone approximately 1 week after hospital discharge to identify those who developed short-term neurologic complications. Results Sixty-three children with a median age of 7 years (interquartile range 3 to 14 years) had posttraumatic seizures, and all but 1 child underwent cranial CT imaging. Ten (16%; 95% confidence interval [CI] 8% to 27%) patients had traumatic brain injuries on CT scan, and all were hospitalized. Three of these 10 patients underwent craniotomy, and 2 patients had further seizure activity. Fifty-two patients had normal cranial CT scan results, and 20 patients were hospitalized for observation. Telephone follow-up was obtained in 31 of the 32 patients with normal CT scan results who were discharged from the ED. None of the 52 patients (0%; 95% CI 0% to 5.6%) with normal cranial CT scan results had further seizure activity or required neurosurgical interventions. Conclusion Children with normal neurologic examination results and normal cranial CT scan results after immediate posttraumatic seizures are at low risk for further short-term complications that require immediate hospitalization. These children may be considered for discharge home from the ED.

CT scan findings in mild head trauma: a series of 2,000 patients.

The present study describes the cranial computed tomography (CT) scan findings of 2,000 cases of mild head trauma (HT) in Curitiba, Southern Brazil. The mean age of the entire series was 30.8 +/-19 years. The overall male to female ratio was 2:1. The most common causes of head injury were interpersonal aggression (17.9%), falls (17.4%), automobile accidents (16.2%), falls to the ground (13.1%) and pedestrian injuries (13 %). Alcohol intoxication was associated with HT in 158 cases (7.9%). A normal CT scan was seen in 60.75% (1215) and an abnormal CT scan in 39.25% (785) of patients. Out of 785 abnormal CT scan, 518(65.9%) lesions were related to HT. The most common CT scan HT related findings were: soft tissue swelling (8.9 %), skull fractures (4.3 %), intracranial and subgaleal hematomas (3.4% and 2.4 %), brain swelling (2 %) and brain contusion (1.2%). Out of 785 abnormal CT scans, 267 (34.1%) lesions were not related to head trauma. Incidental CT scan findings included brain atrophy (5.9%), one calcification (5.2%) several calcifications (2.4%) (probably neurocysticercosis in most cases), ischemic infarct (1.9%) and leukoaraiosis (1.3%). These findings showed the importance of CT scan examination in mild head injuries. Further studies to identify mild HT patients at higher risk of significant brain injury are warranted in order to optimize its use.