CT BRAIN / HEAD - checklist 
​(from foramen magnum to vertex)

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1. Language - Hyperdense / hypoattenuation / effacement / symmetry
2. Establish what anatomical zone of the brain is affected
3. Foramen Magnum - ?tight -  cisterna magna / evidence of herniation
4. Posterior fossa - Medulla, Pons, Cerebellum, 4th ventricle
5. Cerebro pontine angle – pituitary mass?
6. Brainstem – hemorrhage / infarct / CP myelinosis
7. Ventricles – Lateral, third, fourth, aqueduct, temporal horns, posterior horns
8. Cisterns – cisterna magna / suprasellar/ ambient / quadrigeminal / prepontine/ infrapontine – size
9. Vessels – MCA / ACA / PCA – circle of willis / Basilar arteries – hyperdense – early thrombus cva
10. Hyperdense venous sinuses – CVS thrombosis
11. Fissures / sulci / gyri – interhemispheric fissure
12. Evidence of C Oedema – loss grey white differentiation / loss of sulci / slitlike ventricles/ tight cisterns
13. Bone windows

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PATHOLOGY

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1. Hemorrhage - SDH - EDH - ICH - SAH - DAI - AVM
2. Infarction - vascular patterns - MCA /ACA /PCA/ Basilar
3. Trauma
4. Infection
5. ​Malignancy​

CASES FOR PRACTICE

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Case 1:
man presents after a "night out" with ALOC

 
​Answer:
Right hyper dense area right frontoparietal location
heterogenous (orange arrow)
crescent shaped
severe mass effect to left
effacement lateral ventricle
loss of grey white differentiation
evidence of sub falcine herniation (white arrows)

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​Statement:
actively bleeding subdural hemorrhage
subfalcine herniation suggesting significant RICP and possible sub tentorial herniation
imminent ​cerebral oedema

Case 2:
acute onset headache in 23 yo man

 
​Answer:
Hyperdense lesion irregular - heterogenous
Right cerebellar Hemisphere
Extension into 4th ventricle
Filling of suprasellar cistern suggesting increased pressure in posterior fossa
Loss of grey white differentiation 

Consistent with AVM haemorrhage
At risk of Tonsillar herniation - urgent neurosurgical intervention to prevent herniation

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