OJCD  Vol.3 No.3 , September 2013
Significance of computed tomography scans in head injury
Abstract: Background: In view of the growing population and increased vehicle use, traumatic brain injury is becoming the most common and devastating problem especially in young healthy people. It has occupied second place next to cancer as leading cause of death. In this new era of radiology, computed tomography has become the primary modality of choice in the initial assessment of head injury patients as it is widely available, faster and highly accurate in detecting skull fractures and acute intracranial hemorrhage. Aim: It is to demonstrate the importance of ct scanning in the initial treatment planning, follow up and long term management of patients with acute head injury of varying severity. Patients: A retrospective study has been carried out of 100 cases of acute head trauma with positive CT scanning referred to Narayana medical college and hospital, Nellore, India between 30th April 2012 to 1st May 2013 [1 year retrospective study]. Results: The post traumatic intracranial consequences have been collected, reviewed and analyzed, where in 82% of cases males were involved , and most of the injured people belong to the first three decades of life, the main cause being road traffic accident which is growing in incidence in this 21st century. Most of the cases which were studied showed skull fractures, which indicates that there has been significant trauma and in a single case more than one pathology related to cranium has been seen. The most common post traumatic consequences found in the study of adults are contusions, brain edema and intracerebral hematomas, while other sequelae such as subarachnoid hematomas, subdural hematomas and extradural hematomas are encountered less. Diffuse and focal cerebral edema was being the most common pathology following trauma in children. Conclusion: CT scanning is the primary modality of choice in the diagnostic work up of patients with acute head trauma for identifying the various intracranial consequences following head injury especially within 48 hours which helps in the initial assessment, treatment planning, follow up and long term management of patients.
Cite this paper: Singh Tomar, S. , Bhargava, A. and Reddy, N. (2013) Significance of computed tomography scans in head injury. Open Journal of Clinical Diagnostics, 3, 109-114. doi: 10.4236/ojcd.2013.33019.

[1]   Hidayat, S. (1989) Acute head trauma, an evaluation by CT scanning and conventional radiology. DMRD Dissertation, College of Medicine, Mosul University, Mosul.

[2]   Hagga, J.R., Lanzieri, C.F. and Gilkeson, R.C. (2001) CT and MRI imaging of the whole body. Mosby.

[3]   Quayle, K.S., Quayle, K.S., Jaffe, D.M., Kuppermann, N., Kaufman, B.A., Lee, B.C., et al. (1997) Diagnostic testing for acute head injury in children: When are head CT and head radiographs indicated? Pediatrics, 99, 11. doi:10.1542/peds.99.5.e11

[4]   Hydel, M.L., Preston, C.A., Mills, T.J., Luber, S., Blaudean, E. and Deblielux, M.C. (2000) Indications for computerized tomography in patients with minor head injury. The New England Journal of Medicine, 343, 100-105. doi:10.1056/NEJM200007133430204

[5]   Zimmerman, R.A., Bilaniuk, L.T., Genneralli, T., Bruce, D., Dolinskas, C. and Uzzell, B. (1978) Cranial CT in diagnosis and management of acute head trauma. American Journal of Roentgenology, 131, 27-34. doi:10.2214/ajr.131.1.27

[6]   Norlund, A., Marke, L.A., Geijerstam, J.L., Ordoson, S. and Britton, M. (2006) OCTOPUS study investigators. Immediate CT scanning or admission after mild head injury: Cost comparison in randomized controlled trail. BMJ, 333, 469. doi:10.1136/bmj.38918.659120.4F

[7]   Geijerstam, J.L., Ordsson, S. and Britton, M. (2006) Octopous study investigators. Medical outcome after immediate computerized tomography or admission for observation in patients with mild head injury: Randomize controlled trail. BMJ, 333, 465. doi:10.1136/bmj.38918.669317.4F

[8]   Youmans, J.R. (1982) Neurological surgery. Saunders, Philadelphia.

[9]   Khalili, A.H. (1988) The value of a skull XR in the early management of head injury. Postgrad Doctor Middle East, 11, 3891-3893.

[10]   Sutton, D. (2003) Textbook of radiology and imaging. 7th Edition, Curchill Livingstone.

[11]   Swischuk, L.E. (1997) Imaging of the newborn, infant, and young child. 4th Edition, Lippincott Wiliams & Wilkins.

[12]   Zimmerman, R.A., Gibby, W.A. and Carmody, R.F. (2000) Neuroimaging, clinical and physical principles. Springer-Verley, New York.

[13]   Tuny, G.A., Kumar, A., Richardson, R.C., Jenny, C. and Brown, D.B. (2006) Comparison of incidental and non incidental traumatic head injury in children on non-contrast computerized tomography. Pediatrics, 118, 626-633. doi:10.1542/peds.2006-0130

[14]   Hammoud, D.A. and Wasserman, B.A. (2002) Diffuse axonal injuries: Pathophysiology and imaging. Neuroimaging Clinics of North America, 12, 205-216. doi:10.1016/S1052-5149(02)00011-4

[15]   Koo, A.H. and La Rouge, R.L. (1977) Evaluation of head trauma by CT. Radiology, 123, 334-350.

[16]   French, B.N. and Dublin, A.B. (1977) The value of CT scanning in the management of 1000 consecutive cases of head injuries. Radiology, 125, 464.

[17]   Al-rawi, W., Ameen, A. and Altaee, M. (1995) Computerized tomographic scan findings with persistent acute post?traumatic headache. Basrah Journal of Surgery, 1, 74-78.

[18]   Armstrong, P. and Wastie, M.L. (2001) A concise textbook of radiology. Arnold.

[19]   Stark, D.D. and Bradely, W.G. (1995) Magnetic resonance imaging. In: Sosin, D.M., Sniezek, J.E., Waxweiler, R.J., Eds., Trends in death associated with traumatic brain injury, 1979 through 1992. Success and Failure. JAMA, 273, 1778-1780.

[20]   Sosin, D.M., Sniezek, J.E. and Thurman, D.J. (1996) In- cidence of mild and moderate brain injury in the United States. Brain Injection, 10, 47-54. doi:10.1080/026990596124719

[21]   Traumatic Brain Injury (1997) Colorado, Missouri, Oklahoma, and Utah, 1990-1993. Morbidity and Mortality Weekly Report, 46, 8-11.

[22]   SINGH, SURYAPRATAP (2009) An unusual case of a compound depressed skull fracture. Journal of Surgery Pakistan (International), 14, 184-186.

[23]   Gutman, M.B., Moulton, R.J., Sullivan, I., Hotz, G., Tucker, W.S. and Muller, P.J. (1992) Risk factors predicting operable intracranial hematomas in head injury. Journal of Neurosurgery, 77, 9-14. doi:10.3171/jns.1992.77.1.0009

[24]   Bradley, W.G. (1993) MR appearance of hemorrhage in the brain. Radiology, 189, 15-26.

[25]   Holmes, E.J., Forrest-Hay, A.C. and Rakesh, R.M. (2008) Fundamentals of CT imaging. In: Holmes, E.J., Forrest-Hay, A.C. and Misra, R.R., Eds., Interpretation of Emergency Head CT: A Practical Handbook, Cambridge University Press, Cambridge, 3-9.

[26]   Ashikaga, R., Araki, Y., Ishida, O. (1997) MRI of head injury using FLAIR. Neuroradiology, 39, 239-242. doi:10.1007/s002340050401

[27]   Gruen, P. (2002) Surgical management of head trauma. Neuroimaging Clinics of North America, 12, 339-343. doi:10.1016/S1052-5149(02)00013-8

[28]   Zee, C.S., Hovanessian, A., Go, J.L. and Kim, P.E. (2002) Imaging of sequelae of head trauma. Neuroimaging Clinics of North America, 12, 325-338. doi:10.1016/S1052-5149(02)00004-7

[29]   Mittl, R.L., Grossman, R.I., Hiehle, J.F., Hurst, R.W., Kauder, D.R., Gennarelli, T.A., et al. (1994) Prevalence of MR evidence of diffuse axonal injury in patients with mild head injury and normal head CT findings. American Journal of Neuroradiology, 15, 1583-1589.