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CT interpretation is most efficient when specific findings related to the patient’s clinical presentation are sought. In patients with head trauma, first, look for large subdural, epidural, or intracerebral hematomas that require emergency surgical treatment.

Second, using a targeted approach, review each slice for intra and extra-axial blood collections, midline shift, ventricular compression or enlargement (hydrocephalus), and fractures (Table 1). Examine the brain adjacent to the site of impact (evident by scalp swelling or fracture) for coup injures, as well as opposite the site of impact for contra-coup injuries. Examine brain, subdural, and bone windows.

Table 1 Targeted Approach to Head CT Interpretation in Patients with Head Trauma
Figure 5

Intracerebral hematomas.

Hemorrhagic contusions (intra-axial blood) involving the frontal lobes.

Figure 6

Diffuse axonal injury.

Slit-like lateral ventricles due to diffuse cerebral edema. A small (petechial) hemorrhage is caused by shear forces at the gray/white interface when the brain is subjected to a forceful impact.

Figure 9

Linear skull fracture.

A vertically oriented linear skull fracture is visible on the lateral scout skull topogram (arrowheads) and the bone window image (arrow).

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