Dr.

Inge Friska, SpRad

 EPILEPSY
• Common neurological disorder, has varied presentation

• MRI = modality of choice, investigating for an underlying cause

• Can be divided into 2 categories :

• Generalised
• Partial : temporal lobe epilepsy, extratemporal epilepsy
 EPILEPSY
• Etiology :
• Idiopathic
• Cryptogenic : unknown cause
• Provoked : fever, head trauma, drug-induced
• Genetic / developmental : cortical abnormalities, chromosomal disorders
• Acquired : stroke, meningitis, traumatic brain injury, tumours, mesial
temporal sclerosis
 BRAIN INJURY
• Traumatic brain injury

• CT = modality of choice

• Classification :
• Closed head injury
• Penetrating head injury
• PATHOLOGY
• Traumatic subarachnoid heamorrhage
• Subdural hematoma
• Epidural hematoma
• Intraventricular haemorrhage
• Cerebral contusion
INTRAVENTRICULAR HEMORRHAGE
• Presence blood within ventricular system

• Classification :
a. Primary : hypertension, vascular malformation
(aneurysm, AVM), tumours

b. Secondary : extension from other intracerebral

hemorrhages, trauma

• Causing obstructive hydrocephalus

INTRACEBERAL HEMORRHAGE
• = intraparenchymal

• Types :
• Location : basal ganglia, thalamus,
pons, cerebellar, lobar
• Etiology : hemorrhagic venous infarct,
hypertensive hemorrhage, hemorrhagic
transformation on ischemic infarct,
traumatic
CNS INFECTIOUS DISEASE
• Classification :
• By organism : viruses, fungi, parasites
• By location : meninges, ventricular system, brain parenchyma, cerebellum,
brainstem, spinal cord
• By route of transmission : hematogenous spread, direct spread, direct
introduction

• Modality : MRI / CT scan with contrast

 MULTIPLE TRAUMA
• CHEST TRAUMA : rib fractures, flail chest, pulmonary contusion, pulmonary
laceration, pneumothorax, hemothorax.

• ABDOMINAL TRAUMA : liver/splenic/pancreatic/renal/bladder/urethral

injury, bowel injury, pneumoperitoneum

• PELVIC TRAUMA : pelvic fracture

• SPINAL CORD : burst fracture, spinal cord transection

 CHEST TRAUMA
• Rib fractures
• Chest xray : initial examination
• CT scan more sensitive
 CHEST TRAUMA
• FLAIL CHEST
• Fractures of 3 / more consecutive ribs with at least 2 fractures site of
each rib creating a free floating segment of the thoracic wall
• Chest Xray >>
• CT scan better identifies flail segment and other associated injuries
(pneumothorax, pulmonary contusion)
 CHEST TRAUMA
• PULMONARY CONTUSION
• Resulting from blunt chest trauma.
• Usually occur adjacent to bony structures, peripherally located.
• Detectable within 6 hours of injury, resolves in 3 – 14 days
• Complication : respiratory failure, significant pulmonary hemorrhage and
ARDS
 CHEST TRAUMA
• PNEUMOTHORAX
• Presence of gas (air) in pleural space

• Cathegories :

• Primary spontaneous pneumothorax : no underlying lung disease (Marfan

syndrome, alpha 1 antitrypsin def)

• Secondary spontaneous pneumothorax : abnormal lung (bullae, asthma, TB,

neoplasm)

• Iatrogenic / traumatic

• Xray & CT
 CHEST TRAUMA
• Pneumothorax
• Typically demonstrate :
• No lung markings

• Visible visceral pleural edge

• Peripheral space is radiolucent compared to adjacent lung

• Collapse lung

• Tension pneumothorax : (+) displacement of mediastinum and heart and

ipsilateral lung compression
 CHEST TRAUMA
• PULMONARY LACERATION
• Secondary to blunt / penetrating
trauma
• Pulmonary contusion with blebs
(pneumotoceles) with air fluid
levels
• + rib fractures and pneumothorax
 ABDOMINAL TRAUMA
• Blunt and penetrating trauma

• Liver/splenic/pancreatic/renal/bladder/urethral injury, bowel injury,

pneumoperitoneum

• AAST grading (solid organs)

 PELVIC FRACTURES
• Simple / complex

• Type : stable & unstable

• Classification :
• Anteroposterior compression
• Lateral compression
• Vertical shear
• Combined mechanical
 BURST FRACTURE
• Type of compression fracture related to high energy axial loading spinal
trauma that result in disruption of the posterior vertebral body cortex with
retropulsion into the spinal canal

• Most common at L1 (T9-L5)

• General features : loss of vertebral height on lateral view, involves posterior

body cortex, interpedicular widening, bone fragment retropulsion into the
spinal canal, spinal cord contusion
 ACUTE ABDOMEN
• Acute abdominal pain is sudden pain unrelated to trauma, severe

• Causes :
• Acute appendicitis

• Acute cholecystitis

• Bowel obstruction

• Urinary colic

• Acute pancreatitis

• Acute diverticular disease

 ACUTE ABDOMEN
• Modality :
• Plain Xray : supine and erect view/decubitus view
• Ultrasonography
• CT scan
 ACUTE ABDOMEN
• What to examine by plain X-ray :
• Gas pattern
• Extraluminal air
• Soft tissue mass
• Calcifications
• Skeletal pathology
 ACUTE ABDOMEN
• What to examine by ultrasound : solid organs, ascites, pleural effusion

• Who? Patients contraindicated or undable undergo CT scan, pregnant

patient with trauma, pediatric with abdominal pain

• Ultrasound advantages : radiation (-), real time, mobility and flexibility

• FAST : focused assessment with sonography in trauma

• Detect free intraperitoneal fluid
 ACUTE ABDOMEN
• What to examine by CT scan :
• Cause, site and level
• Detecting pneumoperitoneum
• Identifying ureteric stones
• Examining solid organs

• CT advantages : fast, not disturbed by gas and bone, not operator

dependent
ACUTE APPENDICITIS
• Inflammation of vermiform appendix

• CT is most sensitive imaging modality

• Findings :
• Dilated appendix (>6 mm)
• Appendicolith
• Periappendiceal fluid collection
BOWEL OBSTRUCTION
• Radiology is important in confirming the diagnosis and identifying the
underlying cause
• Differentiate true mechanical obstruction from ileus
• Localise the site of obstruction
• Identify an underlying cause
• Asses for complication
• Asses viability of bowel segment involved
 BOWEL OBSTRUCTION
• Divided according to where the obstruction occurs :
• Small bowel obstruction
• Large bowel obstruction

• Findings :
• Transition point
• Dilated bowel loops proximal to transition point : small bowel > 3 cm, large
bowel > 5 cm
• Bowel wall thickening
 BOWEL OBSTRUCTION
• INTUSSUSCEPTION
• Occurs when one segment of bowel is pulled into itself of neighbouring loop of bowel
by peristalsis

• Majority in children

• In adult usually caused by focal lesion acting as a lead point : malignancy, benign tumor,
congenital, inflammatory

• Region : ileocolic, ileoileocolic, ileoileal, colocolic

• Modality : Xray, fluoroscopy, ultrasound, CT scan