Underwent Brain Computed Tomography Research Articles

Prognostic value of gray–white matter ratio measured by brain MRI-based CT structures in comatose patients after cardiac arrest

BackgroundPost-cardiac arrest care advancements have improved resuscitation outcomes, but many survivors still face severe neurological deficits or death from brain injury. Herein, we propose a consistent prognosis prediction approach using magnetic resonance imaging (MRI) to analyze anatomical regions represented by the gray and white matter, and subsequently apply it on computed tomography (CT) to calculate the gray–white matter ratio (GWR). We compared this novel method with traditional measures to validate its ability to predict the prognosis of patients resuscitated after cardiac arrest. MethodsConducted retrospectively at two South Korean tertiary university hospitals from January 2018 to December 2022, the study included adult cardiac arrest survivors treated with therapeutic target temperature management. Patients underwent brain CT within 2 h and brain MRI within 3 days of return of spontaneous circulation. The outcome was the neurological status at discharge. Statistical analyses included receiver operating characteristic curve analysis and determining cutoff values to predict poor neurological outcomes. ResultsOverall, 51 of the 421 adult comatose cardiac arrest survivors examined met the inclusion criteria. Among these, 33 and 18 exhibited good and poor neurological outcomes, respectively. Demographic and cardiac arrest characteristics were compared between the two groups, revealing significant differences. Analyses of gray and white matter attenuation and GWR measurements highlighted significant differences between the good and poor outcome groups. ConclusionOur study introduces a novel method for measuring GWR using MRI-based brain CT, demonstrating superior prognostic accuracy in predicting neurological outcomes in patients with post-cardiac arrest syndrome compared to traditional methods.

Incidence and outcomes of delayed intracranial hemorrhage: a population-based cohort study

Head trauma is a common reason for emergency department (ED) visits. Delayed intracranial hemorrhage (ICH) in patients with minor head trauma is a major concern, but controversies exist regarding the incidence of delayed ICH and discharge planning at the ED. This study aimed to determine the incidence of delayed ICH in adults who developed ICH after a negative initial brain computed tomography (CT) at the ED and investigate the clinical outcomes for delayed ICH. This nationwide population cohort study used data from the National Health Insurance Service of Korea from 2013 to 2019. Adult patients who presented to an ED due to trauma and were discharged after a negative brain CT examination were selected. The main outcomes were the incidence of ICH within 14 days after a negative brain CT at initial ED visit and the clinical outcomes of patients with and without delayed ICH. The study patients were followed up to 1 year after the initial ED discharge. Cox proportional hazard regression analysis was used to estimate the hazard ratio for all-cause 1-year mortality of delayed ICH. During the 7-year study period, we identified 626,695 adult patients aged 20 years or older who underwent brain CT at the ED due to minor head trauma, and 2666 (0.4%) were diagnosed with delayed ICH within 14 days after the first visit. Approximately two-thirds of patients (64.3%) were diagnosed with delayed ICH within 3 days, and 84.5% were diagnosed within 7 days. Among the patients with delayed ICH, 71 (2.7%) underwent neurosurgical intervention. After adjustment for age, sex, Charlson Comorbidity Index, and insurance type, delayed ICH (adjusted hazard ratio, 2.15; 95% confidence interval, 1.86–2.48; p < 0.001) was significantly associated with 1-year mortality. The incidence of delayed ICH was 0.4% in the general population, with the majority diagnosed within 7 days. These findings suggest that patient discharge education for close observation for a week may be a feasible strategy for the general population.

Clinical, imaging, and pathological characteristics of 35 cases of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome

Objective: To summarize the clinical, imaging, and pathological characteristics of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome (MELAS) to improve the diagnosis of this rare disease. Methods: A retrospective case series was conducted to collect the clinical data and results of genetic testing, muscle biopsy, and imaging studies including computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance spectroscopy (MRS) of 35 patients with MELAS admitted to the Nanjing Drum Tower Hospital from 2012 to 2021. Descriptive statistical analysis including mean, standard deviation, and frequency percentage were carried out. Results: The average age of onset of the patients was 30.2±2.3 years; the prevalence of family history was 20%. The two main initial symptoms were limb weakness and convulsions. The clinical manifestations of the neuromuscular system were proximal muscle weakness and exercise intolerance. The endocrine system is the most affected outside the neuromuscular system, with diabetes being the most common condition. Among the five patients who underwent brain CT, four showed hypodense lesions and two had calcified lesions. Brain MRI in 26 patients showed that the lesions more often affected the parietal lobe, basal ganglia, temporal lobe, occipital lobe, and frontal lobe than the infratentorial areas. Twelve of these individuals exhibited different levels of brain atrophy. Among the 10 patients who underwent 1H-MRS, nine showed a decrease in N-acetylaspartate (NAA) levels, eight exhibited abnormal lactate elevation (Lac peaks), whereas six had both reduced NAA levels and the presence of Lac peaks. Thirty-one patients underwent genetic testing; among them, 25 were found to have the mt.3243A>G mutation, while the remaining six exhibited rare gene alterations. Muscle biopsies were performed in 21 patients, and 15 showed abnormal mitochondrial proliferation manifested by ragged red fibers and defective oxidative phosphorylation manifested by cytochrome C oxidase (COX) enzyme-deficient muscle fibers. Conclusion: The clinical manifestations of MELAS syndrome are variable and complex, and early atypical symptoms could be missed or misdiagnosed. A detailed clinical history, imaging MRS analysis, muscle biopsy, and genetic testing are necessary to confirm the accurate diagnosis of MELAS.

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.

Outcome prediction of cardiac arrest with automatically computed gray-white matter ratio on computed tomography images

BackgroundThis study aimed to develop an automated method to measure the gray-white matter ratio (GWR) from brain computed tomography (CT) scans of patients with out-of-hospital cardiac arrest (OHCA) and assess its significance in predicting early-stage neurological outcomes.MethodsPatients with OHCA who underwent brain CT imaging within 12 h of return of spontaneous circulation were enrolled in this retrospective study. The primary outcome endpoint measure was a favorable neurological outcome, defined as cerebral performance category 1 or 2 at hospital discharge. We proposed an automated method comprising image registration, K-means segmentation, segmentation refinement, and GWR calculation to measure the GWR for each CT scan. The K-means segmentation and segmentation refinement was employed to refine the segmentations within regions of interest (ROIs), consequently enhancing GWR calculation accuracy through more precise segmentations.ResultsOverall, 443 patients were divided into derivation N=265, 60% and validation N=178, 40% sets, based on age and sex. The ROI Hounsfield unit values derived from the automated method showed a strong correlation with those obtained from the manual method. Regarding outcome prediction, the automated method significantly outperformed the manual method in GWR calculation (AUC 0.79 vs. 0.70) across the entire dataset. The automated method also demonstrated superior performance across sensitivity, specificity, and positive and negative predictive values using the cutoff value determined from the derivation set. Moreover, GWR was an independent predictor of outcomes in logistic regression analysis. Incorporating the GWR with other clinical and resuscitation variables significantly enhanced the performance of prediction models compared to those without the GWR.ConclusionsAutomated measurement of the GWR from non-contrast brain CT images offers valuable insights for predicting neurological outcomes during the early post-cardiac arrest period.

Strikingly low prevalence of pituitary incidentalomas in a teaching hospital in Uruguay.

Pituitary incidentalomas are an occurrence documented in 10.6% of post-mortem examinations, 4%-20% of computed tomography (CT) scans, and 10%-38% of magnetic resonance imaging (MRI) cases, primarily consisting of microincidentalomas (<1 cm in size). However, the prevalence of pituitary incidentalomas in Uruguay remains unexplored. This study aimed to ascertain the prevalence of pituitary incidentalomas at our hospital. In this investigation, we retrospectively identified patients who underwent brain CT and MRI at our hospital over a 1-year span due to conditions other than suspected or known pituitary disorders. The time frame covered was from 1 January to 31 December 2017. Our analysis encompassed all scans, and we conducted interviews with patients discovered to have pituitary incidentalomas. Furthermore, we conducted biochemical assessments in accordance with clinical and imaging traits. During the study period, a total of 3,894 patients underwent imaging procedures. Of these, 1,146 patients underwent MRI scans, and 2,748 underwent CT scans. The mean age was 53.1 ± 19 years, with a relatively even distribution between genders (50.6% women). The majority of imaging requisitions originated from the emergency department (43%), followed by outpatient clinics (29%), and inpatient wards (28%). Common reasons for imaging requests included trauma (20.4%), headaches (11.3%), and stroke (10.9%). Among these cases, two pituitary incidentalomas were detected, resulting in a prevalence of 5 cases per 10,000 individuals annually (0.051%). Both of these cases were initially identified through CT scans, with subsequent MRI scans performed for further assessment. The final diagnoses were a vascular aneurysm and a sellar meningioma, with the latter patient also exhibiting secondary hypothyroidism. Notably, no instances of pituitary adenomas were encountered. The prevalence of pituitary incidentalomas within our hospital was notably low. Further research is necessary to more comprehensively investigate the occurrence of pituitary incidentalomas in our country.

Both decreased and increased grey-to-white matter attenuation ratio in the putamen and caudate on early head computed tomography differentiate patients with favorable and unfavorable outcomes after prolonged cardiac arrest-secondary analysis of the Prague OHCA study.

Neurological damage remains the leading cause of death in cardiac arrest victims with early neuroprognostication being the cornerstone of the decision-making process to continue or discontinue advanced treatments. In this study, we aimed to find markers of favorable and unfavorable outcome on early brain computed tomography (CT) in patients after prolonged out-of-hospital cardiac arrest (OHCA) treated both by conventional and extracorporeal cardiopulmonary resuscitation (ECPR). In a secondary analysis of the Prague OHCA study, patients who underwent brain CT within 36 hours after cardiac arrest were identified. Qualitative findings (brain edema, hemorrhage) and quantitative measurements [attenuation of grey matter structures and grey-to-white matter attenuation ratio (GWR)] between patients with cerebral performance category (CPC) of 1-2 (favorable outcome) and 3-5 (unfavorable outcome) within 180 days after the event were compared. In 45 eligible patients, intracranial edema (n=16, 50%) was present in patients with CPC 3-5 only (n=32, 71%). Attenuation of brain structures and GWR did not differ between patients with favorable and unfavorable outcomes. However, the GWR in the caudate and putamen of most CPC 1-2 patients was within a narrow range of values (1.18 to 1.30 and 1.20 to 1.33) that separated patients with CPC 1-2 from CPC 3-5 with a sensitivity of 78% and 66% a specificity of 85% and 100%, and area under the curve （AUC） of 0.86 (P=0.0001) and 0.77 (P=0.0053), respectively. Patients treated by ECPR had lower attenuation in the centrum semiovale (28.3±2.7) compared to those who were not (31.0±2.8, P=0.003). The most common causes of death in CPC 3-5 patients were brain death in 13 (41%) patients, multiorgan failure in 12 (38%), and cardiac rearrest in 4 (13%). Both decreased and increased grey-to-white matter differentiation in the putamen and caudate on early non-contrast brain CT after prolonged OHCA indicate poor neurological outcome within 180 days after cardiac arrest.

Measurement of Optic Nerve Sheath Diameter by Computed Tomography in the Pediatric Population: Normal Values.

To determine the normal values of optic nerve sheath diameter (ONSD) by computed tomography (CT) in the pediatric population. The CT scans of pediatric patients aged 1 to 16 years who underwent brain CT for different reasons, who did not have intracranial pathology or increased intracranial pressure, and who had no pathology on CT were included in the study. Four age groups were defined with the following ranges: 1 to 2, 3 to 6, 7 to 10, and 11 to 16 years. ONSD was measured from axial CT images, 3 and 10 mm behind the optic globe. The normative values of ONSD measured on CT imaging in children aged 1 to 16 years were reported. The change in ONSD according to age was investigated. ONSD was found to increase with age at both levels measured. The difference was statistically significant. Normal values should be known to detect pathologies that may cause an increase in optic nerve diameter. The values reported in this study can serve as a reference for normal optic nerve sheath diameter in the pediatric age group. [J Pediatr Ophthalmol Strabismus. 2024;61(1):38-43.].

Prevalence and independent predictors of in-hospital stroke among patients who developed acute alteration of consciousness in the medical intensive care unit: A retrospective case-control study.

In-hospital stroke is a serious event, associated with poor outcomes and high mortality. However, identifying signs of stroke may be more difficult in critically ill patients. This study investigated the prevalence and independent predictors of in-hospital stroke among patients with acute alteration of consciousness in the medical intensive care unit (MICU) who underwent subsequent brain computed tomography (CT). This retrospective study enrolled eligible patients during the period 2007 - 2017. The alterations researched were radiologically confirmed acute ischaemic stroke (AIS) and intracerebral haemorrhage (ICH). Of 4 360 patients, 113 underwent brain CT. Among these, 31% had AIS, while 15% had ICH. They had higher diastolic blood pressures and arterial pH than non-stroke patients. ICH patients had higher mean (standard deviation (SD) systolic blood pressures (152 (48) v. 129 (25) mmHg; p=0.01), lower mean (SD) Glasgow Coma Scale scores (4 (3) v. 7 (4); p=0.004), and more pupillary abnormalities (75% v. 9%; p<0.001) than AIS patients. AIS patients were older (65 (18) v. 57 (18) years; p=0.03), had more hypertension (60% v. 39%; p=0.04), and more commonly presented with the Babinski sign (26% v. 9%; p=0.04). Multivariate analysis found that pupillary abnormalities independently predicted ICH (adjusted odds ratio (aOR) 26.9; 95% CI 3.7 - 196.3; p=0.001). The Babinski sign (aOR 5.1; 95% CI 1.1 - 23.5; p=0.04) and alkalaemia (arterial pH >7.4; aOR 3.6; 95% CI 1.0 - 12.3; p=0.05) independently predicted AIS. Forty-six percent of the cohort had ICH or AIS. Both conditions had high mortality. The presence of pupillary abnormalities predicts ICH, whereas the Babinski sign and alkalaemia predict AIS. The present study reports that almost half (46%) of critically ill patients with alterations of consciousness had an acute stroke. Of these, two-thirds had an acute ischaemic stroke (AIS), and one-third had an intracranial haemorrhage (ICH). Multivariate analysis revealed that a pupillary abnormality was a predictor for ICH and the Babinski sign was identified as a predictor of AIS.

COMPUTED TOMOGRAPHY FINDINGS OF INTRACRANIAL CALCIFICATIONS

Objective&#x0D; In this study, the anatomical localization and&#x0D; distribution of intracranial calcifications detected on&#x0D; brain computed tomography (CT) were determined&#x0D; and their relationship with age and gender was&#x0D; investigated.&#x0D; Material and Method&#x0D; Images of 887 patients who underwent brain CT&#x0D; examinations for various reasons between March&#x0D; 2010 and May 2013 were analyzed. Images of 124&#x0D; patients were excluded from the study because of&#x0D; contrast-enhanced examination, bleeding, trauma,&#x0D; hydrocephalus, and image distortion. Seven hundred&#x0D; sixty three patients whose non-contrasted brain CT&#x0D; images were analyzed were divided into age groups&#x0D; according to decades. The pineal gland, choroid&#x0D; plexus, habenula, basal ganglia, tentorium cerebelli,&#x0D; falx cerebri, dural and arachnoid granulation,&#x0D; petroclinoid ligament, arterial wall, orbital, dystrophic&#x0D; and tumoral calcifications were evaluated. The&#x0D; distribution of intracranial calcifications according to&#x0D; age groups and gender were examined.&#x0D; Results&#x0D; Of the patients included in the study, 382 (50.1%)&#x0D; were female and 381 (49.9%) were male. Intracranial&#x0D; calcification was detected in 672 (88.1%) of the patients.&#x0D; The choroid plexus (78.2%) calcifications were most&#x0D; common, followed by habenula (62.4%), pineal gland&#x0D; (55.3%), arterial wall (31.2%), petroclinoid ligament&#x0D; (28.7%), and falx cerebri (20.7%). Calcifications of&#x0D; dural and arachnoid granulation (7.5%), basal ganglia&#x0D; (6.3%), tentorium cerebelli (2.9%), tumoral (1.2%)&#x0D; and orbital (0.5%) were detected less frequently,&#x0D; while dystrophic calcifications (0.4%) were the least&#x0D; common. A statistically significant difference was&#x0D; found in the distribution of calcifications according&#x0D; to age groups, in calcifications located in the pineal&#x0D; gland, choroid plexus, habenula, basal ganglia,&#x0D; tentorium cerebelli, falx cerebri, dural and arachnoid&#x0D; granulation, petroclinoid ligament and arterial wall. A&#x0D; statistically significant difference was found in choroid&#x0D; plexus, habenula, dural and arachnoid granulation&#x0D; and petroclinoid ligament calcifications in distribution&#x0D; according to gender.&#x0D; Conclusion&#x0D; Intracranial calcifications are most frequently detected&#x0D; in the choroid plexus, habenula and pineal gland,&#x0D; while dystrophic calcifications are seen the least.&#x0D; The incidence of intracranial calcifications generally&#x0D; increases from the age of 10. Tentorium cerebelli and&#x0D; dural and arachnoid granulation calcifications are&#x0D; more common in female.

The relationship between abnormal intracranial findings in brain computed tomography and antiplatelet or anticoagulant use in patients with nontraumatic headache: a prospective cohort study.

ObjectiveThis study aimed to investigate the relationship between abnormal intracranial findings on brain computed tomography and antiplatelet or anticoagulant use in patients with nontraumatic headache in the emergency department (ED).MethodsThis was a single-center prospective observational study of patients admitted to the tertiary ED with complaints of nontraumatic headache between May 1, 2016 and September 1, 2016. Anticoagulant or antiplatelet drug use by the patient was recorded. Brain computed tomography (CT) results were categorized into two groups, abnormal results (CT positive) and no pathologic results (CT negative), and compared. The CT positive group included any pathological signs in the brain and the negative group was considered a normal read. A logistic regression analysis was used for evaluating the association of antiplatelets and anticoagulants with abnormal CT findings.ResultsOf the 837 patients with nontraumatic headaches, 157 (18.8%) patients who underwent brain CT scanning were included. The mean age of the patients was 44.4±16.7 years. Eighty-eight (56.1%) of the patients were women. Of the 29 (18.4%) patients using antiplatelets or anticoagulants, 16 (55.2%) were in the CT positive group. There was a statistically significant difference between both groups in terms of drug use compared to the CT negative group (P<0.001). Factors affecting CT results were examined in logistic regression analysis and a statistically significant difference was found in the detection of positive results in antiplatelet or anticoagulant drug users (adjusted odds ratio, 2.478; 95% confidence interval, 1.006–6.102; P=0.048).ConclusionThe use of antiplatelets or anticoagulants in patients admitted to the ED with nontraumatic headache is associated with an increased risk of abnormal intracranial results in brain CT.

Prevalence of Epilepsy, Human Cysticercosis, and Porcine Cysticercosis in Western Kenya.

Cysticercosis is the leading cause of acquired epilepsy worldwide and has been shown to be highly prevalent in pig populations in western Kenya. We conducted a community-based door-to-door survey in a region of western Kenya with a high proportion of pig-keeping households. Persons with epilepsy (PWE) were determined using a screening questionnaire followed by a neurologist evaluation. Cysticercosis serum apDia antigen ELISAs and Western blot for LLGP and rT24h antigen were performed on all PWE and 2% of screen-negative patients. All PWE or people with positive apDia underwent contrast-enhanced brain computed tomography (CT). Of a sample of 810 village residents, 660 (81%) were present in the homestead, of whom 648 (98%) participated. Of these, 17 were confirmed to have lifetime epilepsy, an estimated crude prevalence of 2.6%. No humans with (N = 17) or without (N = 12) epilepsy had serological evidence of cysticercosis infection. Fourteen PWE and one individual with borderline positive apDia antigen ELISA underwent brain CT; none had radiographic findings consistent with neurocysticercosis. Nearly 30% of households kept pigs, with 69% always tethered in both wet and dry seasons. More than 8% (6/72) of pigs had palpable lingual cysts; these pigs all originated from homesteads with latrines, one-third of which were free-ranging at least some of the time. Epilepsy prevalence in our study was greater than the national prevalence, but we found no individuals with epilepsy attributable to cysticercosis. Additional studies are required to identify causes of epilepsy, human and porcine cysticercosis, the role of spatial clustering, and protective factors like host-pathogen immunity.

Clinical Significance of Gray to White Matter Ratio after Cardiopulmonary Resuscitation in Children.

Cardiopulmonary resuscitation (CPR) successfully restores systemic circulation approximately 50% of the time; however, many successfully restored patients have severe neurologic damage. In adults, the gray matter to white matter attenuation ratio (GWR) in brain computed tomography (CT) correlates with the neurologic outcome. However, in children, the clinical significance of GWR still remains unclear. The aim of this study was to evaluate the clinical characteristics of children who underwent CPR for cardiac arrest according to the survival and to demonstrate the differentiation of grey/white matter by Hounsfield units of brain CT and to characterize the attenuations of grey and white matters. Methods: This is a retrospective single-center study. We enrolled those who underwent brain CT within 24 h after return of spontaneous circulation (ROSC) from January 2005 to June 2018. Brain CTs were taken within 24 h of ROSC. We measured the attenuation of grey and white matter in Hounsfield units and calculated GWR. They were compared with healthy controls. Patients were analyzed as follows: survivors vs. non-survivors and better neurologic outcome vs. worse neurologic outcome. Results: Among 100 pediatric patients who had CPR, 56 met inclusion criteria. There were 24 patients who survived and 32 non-survivors. Our study revealed that the incidence of seizure, duration of CPR, and instances of hypothermia were significantly different between survivors and non-survivors. In both survivors and non-survivors, the attenuation of the caudate nucleus, putamen, GWR-basal ganglia, and average GWR were significantly different from controls. In regression analyses, the medial cortex and average GWR were the significant variables to predict survival, and the receiver operating curves revealed areas under curve of 0.733 and 0.666, respectively. Also, the medial cortex 1 was the only variable that predicted the neurologic outcome. Conclusions: There was some predictive survival value of GWR and medial cortex at the centrum semiovale level in early brain CT within 24 h after cardiac arrest. Although we could not find the predictive value of GWR in the neurologic outcome of pediatric patients, we found that the absolute attenuation of the medial cortex was low in patients with worse neurologic outcomes. Further prospective, multicenter studies are needed to determine the predictive value of GWR and the medial cortex.

CORRELATION OF COMPUTED TOMOGRAPHY AND INTRAOPERATIVE FINDINGS WITH CLINICAL SYMPTOMS IN HEAD TRAUMA PATIENTS

Hematoma in different parts of the brain is one of the most important complications of head injury and is associated with high mortality and morbidity rate. The aim of this study was evaluation of the relationship between Computed Tomography (CT) and intraoperative findings with clinical symptoms in head trauma patients. In this study 95 patients with cerebral hemorrhage due to head trauma, referred to Taleghani Hospital in Kermanshah were studied. After an initial clinical examination, the level of consciousness determined according to the Glasgow Coma Scale (GCS) was recorded. All patients underwent brain CT scan and findings were recorded, including size and location of the hematoma. Patients in all treatment such as surgical procedures under the supervision, and the information on their status was recorded until discharge or death. It was found that most patients (38%) were between 40-20 years: 73% of patients were male, while 27% were female. The outcome of 35 patients (35.4%) were normal, 12 patients (12.3%) had moderate disability, 9 patients (9.2%) had severe disability, 11 patients (10.8%) vegetative state and 31 patients (32.3%) died. There was a significant association between location of the hematoma and hematoma in CT scan and outcome of patients with cerebral hemorrhage caused by trauma (P&lt;0.05). We also found a significant association between size of the hematoma and midline shift in CT scan with outcome of patients with cerebral hemorrhage caused by trauma (P&lt;0.05). The prognosis of patients with traumatic brain injury depends on location of the hematoma; volume of hematoma, midline shift in CT scan and length of trauma to surgery more than 4 hours.

Delayed post-traumatic Tension Hydropneumocephalus; a Case Report of Conservative Treatment

Pneumocephalus refers to the presence of air in the cranial cavity. Trauma is the most common cause of acquired pneumocephalus. Tension pneumocephalus occurs when intracranial accumulation of air causes high pressure on the brain as compared to extracranial pressure. Tension pneumocephalus is usually acute, and causes neurological symptoms, and its delayed form rarely occurs. A 12-year-old girl presented with a headache, lethargy, mild fever, and nausea from two days before admission to emergency department of Shahid Rajaei Hospital, Qazvin, Iran. The patient had a history of head trauma in a driving accident six weeks before and had undergone brain computed tomography (CT) scan in another centre, which had revealed no sign of pneumocephalus. The patient had been treated for one week and had been discharged in good general condition. Considering her reduced consciousness, the patient underwent brain CT scan again in our centre. CT scan revealed tension hydropneumocephalus. The patient was transferred to the intensive care unit (ICU) for treatment. Considering the trend of her recovery, the patient was a candidate for conservative non-surgical therapy based on the in-charge neurosurgery specialist’s decision. The patient reported no complications during the six-month follow-up. Delayed tension pneumocephalus is among neurosurgery emergencies usually treated with early surgical intervention and dura defect restoration, but this patient received non-surgical treatment without any serious problem during the six-month follow-up.

Brain Computed Tomography in Stimulant Poisoning with Altered Consciousness.

Stimulant poisoning frequently causes altered mental status (AMS) and can result in severe cerebral vascular complications. The role of noncontrast brain computed tomography (CT) in acute stimulant-poisoned patients presenting with AMS remains unclear. We examined the results and impacts of brain CT in acute stimulant-poisoned patients with AMS. We performed a retrospective single-center study that included all adult patients who presented to the emergency department with stimulant poisoning and AMS (Glasgow coma scale [GCS] score <15) between January 1, 2010 and December 31, 2017. Patients who had concomitant head trauma or who presented with focal neurologic symptoms were excluded. The primary outcome was the rate of acute abnormalities on brain CT. The secondary outcomes were to identify factors that affected the decision to perform brain CT in stimulant-poisoned patients with AMS and whether obtaining the brain CT scan itself affected the patients' prognoses. The analysis included 66 patients, of whom 6 died from the poisoning. Noncontrast brain CT was performed in 31 patients and none had acute abnormalities. Patients who underwent brain CT were found to have worse GCS scores, higher body temperatures, higher intubation rates, higher admission rates, longer admission periods and intensive care unit stays, and a higher mortality rate. After adjusting for the propensity score, performing brain CT itself did not independently affect the patients' clinical outcomes. Nontrauma stimulant-poisoned patients presenting with AMS and without focal neurologic symptoms were unlikely to have acute abnormalities on brain CT. Patients who underwent brain CT scans had worse consciousness and greater disease severity.

Grey–white matter ratio measured using early unenhanced brain computed tomography shows no correlation with neurological outcomes in patients undergoing targeted temperature management after cardiac arrest

AimThis study evaluated whether the grey–white matter ratio (GWR) assessed via early brain computed tomography (CT) within 2 h after the return of spontaneous circulation (ROSC) following cardiac arrest is associated with poor neurological outcomes after 6 months in post-cardiac arrest patients treated with targeted temperature management (TTM). MethodsThis study used data from the Korean Hypothermia Network prospective registry obtained from November 2015 to October 2017 to assess patients with out-of-hospital cardiac arrest (OHCA) who underwent brain CT within 2 h following the ROSC. The primary endpoint was the neurological outcome 6 months post-cardiac arrest (cerebral performance category; CPC). The GWR was measured using early brain CT images. The subgroup analysis examined the difference in GWRs obtained from early and repeated brain CT. ResultsFive-hundred-twelve patients were enrolled. Good (CPC 1–2) and poor (CPC 3–5) neurological outcomes were observed in 162 (31.6%) and 350 (68.4%) patients, respectively. The multivariate logistic regression analysis revealed that the GWR measured using early brain CT was a statistically nonsignificant predictor of poor neurologic outcomes (p = 0.727). In patients with poor outcomes, the mean GWR obtained from early and repeated CT images were 1.171 ± 0.058 and 1.091 ± 0.133, respectively (p < 0.001); there was no statistically significant difference between the GWRs in patients with good outcomes. ConclusionThe GWR assessed via early brain CT alone is not an independent factor predictive of poor neurologic outcomes but could be useful when used with repeated CT data.

Effectiveness of peer pressure on computed tomography use for dizziness/vertigo patients.

Dizziness/vertigo is a common complaint in the emergency department (ED). We aimed to evaluate the effect of peer pressure on decision making in emergency physicians (EPs) to use computed tomography (CT) for patients with dizziness/vertigo.We conducted a before-and-after retrospective case review of patients who visited the ED with dizziness/vertigo. EPs were categorized into 3 groups according to seniority (in years of experience: >12, 7–12, and <7). The rate of CT use for EPs, patient number, and CT use were e-mailed monthly to update the EP team on the benchmark rate and shape of the behavior.Among the 1657 (preintervention) and 1508 (postintervention) patients with dizziness/vertigo, 320 (19.3%) and 230 (15.3%), respectively, underwent brain CT. A decrease in the rate of CT use was observed in the postintervention group (odds ratio [OR] = 0.743, 95% confidence interval [CI] = 0.615–0.897), especially in junior EPs (years of experience, <7; OR = 0.667, 95% CI: 0.474–0.933) and younger patients (age, <60) (OR = 0.625, 95% CI: 0.453–0.857).The intervention strategy created peer pressure through e-mail reminders and decreased the rate of CT use for patients with isolated dizziness/vertigo, especially in junior EPs and younger patients.

Usefulness of a quantitative analysis of the cerebrospinal fluid volume proportion in brain computed tomography for predicting neurological prognosis in cardiac arrest survivors who undergo target temperature management

PurposeBrain swelling post-cardiac arrest may affect cerebrospinal fluid volume. We aimed to investigate the prognostic performance of the proportion of cerebrospinal fluid volume (pCSFV) using brain computed tomography (CT) in cardiac arrest survivors. Materials and MethodsThis retrospective multicentre study included adult comatose cardiac arrest survivors who underwent brain CT scan prior to target temperature management (TTM) from 2015 to 2016. Grey-to-white matter ratio (GWR) and pCSFV values were calculated. pCSFV analysis was performed using automated quantitative analysis programming. The primary outcome was a 6-month neurological outcome. ResultsOf 251 patients (median age, 57 years), 173 (68.9%) were male, 87 (34.7%) had a shockable rhythm, and 160 (63.7%) had unfavourable neurological outcomes. GWR but not pCSFV was significantly higher in terms of favourable neurological outcomes (p = .015). pCSFV prognostic performances were similar to GWR, and were poor overall, (0.521; 95% confidence interval [CI], 0.446–0.694 vs. 0.515; 95% CI, 0.441–0.589). After adjusting for covariates, pCSFV but not GWR was independently associated with neurological outcome 6 months following cardiac arrest (p = .049). ConclusionpCSFV was independently associated with neurological outcome 6 months following cardiac arrest, however prognostic performance was not good.

Imaging Findings of Children Stroke in Burkina Faso and Etiological Approach

Introduction: Stroke is defined as a sudden onset focal neurological deficit of presumed vascular origin. Although it is essentially adult and elderly condition, stroke can occur in children. Their diagnosis essentially radiological is based on two main imaging modalities namely Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI). Our study aimed to study radiological features of stroke in children with an etiologic approach in three health facilities of Ouagadougou. Material and Method: We conducted a retrospective study with descriptive focus during 11-year period from January 1st, 2006 to September 1st, 2017 among children aged between 02 months and 16 years who underwent brain CT scan and/or MRI; in whom diagnosis of stroke had been established in radiology department of Yalgado Ouedraogo Teaching Hospital (CHU-YO), Schiphra Methodist Medical Center (CM Schipphra) and Saint Camille Hospital of Ouagadougou (HOSCO). Results: 40 cases of pediatric stroke were collected including 23 at HOSCO, 15 at CHU-YO and 03 at CM Schipphra. Mean age was 6.45 years, with extremes of 2 months and 192 months. Unilateral contralateral motor weakness was the most common clinical presentation (32.5%) followed by seizures (17.5%). Ischemic stroke dominated in 82.5% of cases. Sino-venous thrombosis was rare and suspected in only one case. Sylvian artery was mostly affected in ischemic stroke for 56.25% of patients. The main etiologic factors found were hematologic (67.50%) then infectious factors (25%). Sickle cell disease was always incriminated in hematologic factor. Homozygous SS patients were the most numerous (82%). Conclusion: Stroke diagnosis in children is based on etiologic investigation, biology with a major role of medical imaging. Sickle cell disease accounts a lot in occurrence of stroke in children in our context.