CTcase study
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A 30-year-old female presented with headaches and right-side weakness for two years. CT and MRI revealed a large left parietal meningioma. The tumor was surgically removed, but the patient later developed an epidural hematoma, shown on follow up CT scans. An external ventricular drain was placed to reduce intracranial pressure. Meningiomas are usually benign brain tumors that can cause symptoms like headaches. Epidural hematomas are collections of blood between the skull and dura that require evacuation to prevent brain damage. The patient was treated for both conditions and followed up with imaging.
CTcase study
- 1. CT Case Study - 2010 Done by: Shatha Jamal Al-Mushayt
- 2. OutlinePatient HistoryExams Needed:CTMRICTFindings & Images Brief Introductions on FindingsTreatment planPrognosisReferences
- 3. Patient History 30 years old female with headache and RT side weakness for the last 2 years.The CT showed large LT parietal mass lesion. So, an MRI was needed.
- 4. MR ImagesThe MRI done at 21-3-2010 shows large LT intraventricular mass most likely meningoma.On T2 appears intermediate/low intensityOn T1homogenuosly isointensePost contrast fairly homogenous intense enhancement. MR Images>>
- 7. Enhanced LT intraventricular mass MRI
- 8. Enhanced LT intraventricular mass MRI
- 9. Then…Based on the previous result, an operation was done to remove the tumor.
- 10. Then…Post excision, the patient presented with severe headache. At 13-5-2010, CT brain plain images were taken.This showed, LT frontal epidural hematoma associated with mass effect on the ipsilateral, midline shift. Hematoma is a complication of the operation.
- 11. An external ventricular drain (EVD) was also inserted.CT brain plain images were then taken at 16-5-2010 for follow up.
- 12. Findings Comparison was made with the 13-5-2010 CT scan study and revealed: No remarkable interval increase in the size of the large epidural liquefied hematoma filling the surgical bed at the LT frontal area.Significant mass effect on the adjacent brain parenchyma
- 13. Finding cont.Significant shift of the anterior midline structures.There is mild dilatation of the supratentorial ventricular system, more pronounced at the LT temporal horn and RT lateral ventricle.The rest of the study almost remains unchanged. (13&16 /5/2010 CT images) 16-5-2010 CT Images>>
- 14. Scout Images PA image: The EVD small tube Lateral image: The operation cut (circle)and the EVD tube(yellow arrow).
- 15. CT Axial Images Epidural hematoma in the LT frontal area starts to show in this slice.Epidural hematoma in the LT frontal area appears convex in shape. Epidural hematomas usually appear convex in shape because their expansion stops at skull's sutures.CT Axial Images Midline shift due to hematomaFlattened gyrus & sulcusdue to hematoma mass effect.. Compare it with the RT hemisphere. the are areas of isodensity in the hematoma (comparing with the brain tissue density) indicates the beginning of being subacute hematoma while the hyperdense area indicates fresh blood. CT Axial Images There is mild dilatation of the supratentorial ventricular system, more pronounced at the LT temporal horn and RT lateral ventricle.Dilated RT anterior horn Dilated RT ventricular body
- 16. Brief introduction on the findings
- 17. Epidural Hematoma Hematoma, is a collection of blood outside the blood vessels, generally the result of hemorrhage,An epidural hematoma lies outside the duramater between the dura and the skull.
- 18. Epidural Hematoma cont.Buildup of blood compresses adjacent delicate brain tissue and increases pressure in the intracranial space which can damage the rest of the brain.epidural hematoma usually appears convex in shape as the blood has to push hard to move outward in the tight space between the inner surface of the skull and the outer surface of the dura mater.
- 19. Treatment Plan forEpidural HematomaEvacuation: small holes are bored through the skull and then the clot is removed either manually or by suction (evacuation procedure). IV Mannitol(medication): it is a diuretic used to reduce pressure and swelling around the brain.Craniotomy: a cut that opens the cranium, to remove a blood clot.Follow up by CT.
- 20. PrognosisOutcome after surgical evacuation of is directly related to the level of consciousness before surgery.An outcome study on individuals with epidural hematoma suggests that 23% have a poor outcome, and 77% have good recovery to moderate disability following surgery
- 21. MeningiomaA meningioma is a tumour of the meninges, which are the protective membranes around the brain and spinal cord.
- 22. MeningiomaCauses: in most cases is unknown; while some are familial.Persons who have undergone radiation to the scalp are more at risk for developing meningiomas.Symptoms:Headache Weakness on one sideSeizuresPersonality and behavioral changes Confusion
- 23. Stands for External Ventricular Drain. Some people have an increase of fluid in the brain puts pressure on the brain intracranial pressure. To reduce the pressure, an EVD (a small tube) is inserted into the brain ventricle to drain the extra fluid. What is an EVD?
- 24. How does an EVD work?The fluid flows from the brain, throughthe EVD, and into a bag. The bag hangs on the head of the patient’s bed or on an IV pole.The doctor & nurse check how much fluid drains into the bag.It is used for a period of time and then is removed.
- 25. Thank You …
- 26. References This take presented at KKUH. http://www.abta.org/Tumor_&_Treatment_Info/Meningiomas/231http://www.upmc.com/HealthAtoZ/patienteducation/Documents/ExtVentricularDrain.pdfhttp://radiopaedia.org/articles/subfalcine_herniationhttp://en.wikipedia.org/wiki/External_ventricular_drainhttp://www.mdguidelines.com/epidural-hematomahttp://en.wikipedia.org/wiki/Meningiomahttp://www.macmillan.org.uk/Cancerinformation/Cancertypes/Brain/Typesofbraintumours/Meningioma.aspx
Editor's Notes
- #11: Ipsilateral: On the same side.