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By Jorge Soto, Brian Lucey

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In the setting of severe head trauma, many of these different types of injuries may coexist. The mechanism of injury should correspond with the degree of injury. , “Trauma X” and “shaken-baby syndrome”) should be considered. Infants, children, persons with mental or physical disabilities, and elderly persons are particularly at risk. Skull fractures, SAH, SDH, contusions, shear injuries, infarcts, vertebral compression fractures, and retinal hemorrhages constitute the usual neuroradiologic spectrum of abnormalities.

Many centers have adopted immediate CTA in their protocol for the workup of spontaneous SAH (Fig. 1-23). If a ruptured aneurysm is detected by this method, detail may be adequate for treatment planning in certain situations. However, other investigators have offered the opinion that the gold standard of DSA (with 3D rotational angiography) provides greater sensitivity and should not yet be replaced by CTA. This opinion is based on reports of a 10% false-negative rate of CTA for aneurysm detection and the belief that the greater spatial resolution of DSA is necessary to accurately determine proper triage to surgery versus endovascular coiling.

SAH is reported in approximately 20% of intracranial internal carotid dissections and more than 50% of intracranial vertebral dissections. T he supraclinoid segment of the internal carotid artery and the segment of the vertebral artery near the posterior inferior cerebellar artery (V4) are the most common sites of intracranial dissection. The cause of intracranial dissection remains unknown, with some instances related to trauma or underlying connective tissue disorders (such as fibromuscular dysplasia, Marfan, and Ehlers-Danlos types).

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Emergency Radiology by Jorge Soto, Brian Lucey

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