CT Brain Temp (Lesion)

Short Prelim

CT Brain NC

No

  • intracranial hemorrhage,
  • extra-axial collection,
  • acute large territorial infarction,
  • midline shift or brain herniation

identified.

CT Brain with CM

For CTA

Add

  • (+) No large vessel occlusion,
  • (+) No aneurysm, dissection or other neurovascular abnormality identified.

For Post-contrast

Add

  • (+) No abnormal enhancing lesion,

identified.

Infarction

Territorial Infarction

There is/are (large) [well | ill]-defined hypodense lesion(s) involving

  • [cortical | subcortical] areas of {lobe}

  • (+) with associated brain swelling

likely {time} (large) territorial infarction of {artery} territories.

Segmental Infarction

A [well | ill]-defined, wedge-shaped hypodense lesion involving ___, likely {time} segmental infarction of the {artery}.

Lacunar

[A few | several] (small) well-defined hypodense lesions at ___

likely chronic lacunar infarction(s) (or dilated perivascular space).

Small VV dz

(Mild) patchy ill-defined hypodense [changes | lesions] involving (at)

  • [lt | rt | bilat] corona radiata

(These can DDx: CSF resorption)

  • {side} {lobe} white matter
  • periventricular white matter of {lobe}
  • deep white matter at bilateral cerebral hemispheres

probably representing ischemic white matter change related to [mild | moderate | severe] degree of small vessel disease (or transependymal CSF resorption).

IMPRESSION:

  • (Mild) degree of small vessel disease.

Chronic Infarction

A wedge-shaped hypodense lesion at ___,

likely chronic infarction of the ___ artery territory.

Time Changes

  • Subacute -> Chronic: increased conspicuity and decreased attenuation

Hemorrhage

History

Known case of ___ with motorcycle accident and struck ??? to the ground.

SDH

[There is development of | Newly seen | New]

  • (+) [Acute | Subacute | Chronic] subdural hematoma (SDH) along

    • {side} ___ convexity,
    • {side} tentorium cerebelli

+ Thickness

  • measuring up to ?? cm in maximal thickness.

  • {location-1} (? cm-thick), {location-2} (? cm-thick)

Other variant

  • crescent-shaped [isodense | hyperdense] lesion along ___ convexity, about ?? cm in maximal thickness; likely representing [Acute | Subacute | Chronic] (on chronic) subdural hematoma (SDH).

IMPRESSION:

  • {time} SDH along ___, measuring up to ? cm in maximal thickness.

  • [Increased | decreased] thickness of __ subdural hematoma (SDH) along __.

  • Thin (? mm) [Acute | Subacute | Chronic] SDH along ___.

Acute-on-chronic SDH

  • Mixed hyper-hypodense subdural collections along ___, measuring up to 😳 cm, representing acute on chronic subdural hematoma (SDH).

IMPRESSION:

  • Acute ontop chronic SDH along ___.

Thin SDH (doubtful)

  • Suspected thin hyperdense extra-axial lesion versus CT artifact at ___, measuring about ? mm in maximal thickness.

IMPRESSION:

  • Thin (? mm) hyperdense extra-axial lesion at ___, possibly CT artifact or thin acute subdural hematoma. Follow-up is recommended.

EDH

  • A small acute epidural hematoma at the ___.

SAH

SAH along

  • (+) [left | right | bilateral] cerebral sulci
  • (+) basal cistern
  • (+) [interpeduncular | perimesencephalic] cisterns
  • (+) [bilateral] MCA cistern
  • (+) [left | right | bilateral] Sylvian fissure.

Intraparenchymal

Structure

{time} intraparenchymal hemorrhage epicenter at the ____, involving ???

  • (+) with blood spillage into ___ ventricle

  • (+) with perilesional edema involving ____ {pressure effect ?}

Chages

  • (interval) [decreased | increased | no significant change] (in) size and density of ___

IMPRESSION:

  • Acute intraparenchymal hematoma (? ml), centered at the , involving _.
    • (+) with a few foci of active contrast extravasation

(This likely represents hypertensive hemorrhage.)

Contusion

Hemorrhagic brain contusion at ___

Subgaleal hematoma

Calvarium and scalp: Acute subgaleal hematoma (with associated scalp swelling) at ___ region, measuring about ? cm in maximal thickness.

IMPRESSION:

  • Acute subgaleal hematoma with associated scalp swelling at ___ region.

Active Bleed

Spot sign

  • CTA and post contrast series show few enhancing foci within this hematoma (spot sign), suggestive of active contrast extravasation.

IMPRESSION:

Acute intraparenchymal hematoma …… with (a few) foci of active contrast extravasation

Multi-compartment

Overall [decreased | increased | no change of] attenuation of multi-compartment intracranial hemorrhages, details as follows:

  • [decreased | increased | no change of] blah blah
  • …

Examples

  • (intraparenchymal): {time} intraparenchymal hemorrhage (with perilesional edema) at ___ lobe, about ?x?x? cm in greatest transaxial and vertical dimensions, respectively.

  • (air-blood-fluid): extra-axial air-blood-fluid collections along ___, measuring up to ? cm in maximal thickness.

  • (IVH): (small) intraventricular hemorrhage (IVH) at ___.

  • (SAH): (acute) subarachnoid hemorrhage (SAH) along ___.

  • (Air): pneumocephalus along ___ convexity.

IMPRESSION:

Chronological change of multi-compartmental intracranial hemorrhage, including

  • Acute {some-important-hemorrhage} …

Pressure Effect

Abbr: midline shift or brain herniation

Full

  • [left | right | bilateral] uncal herniations
  • descending transtentorial herniations
  • crowding of the foramen magnum
  • tonsillar herniation

No / Not change

No uncal herniation, descending transtentorial herniations, crowding of the foramen magnum, or tonsillar herniation is seen.

No significant change of pressure effects, seen as …

Yes

(Associated) pressure effect [causing | is seen as] …

  • (+) brain swelling

  • (+) ?-mm rightward | leftward midline shift

  • (+) (impending) ___ herniation

  • (+) effacement of the adjacent

    • [left | right | bilateral] {lobe} ___ sulci,
    • ___ ventricle.

IMPRESSION:

  • Increased pressure effects are seen as

Calcification

Normal Calcification

Ref: Normal intracranial calcification

A (small) (dense) calcification(s) [at | along]

  • [bilateral] globus pallidus.
  • falx cerebri
  • pineal gland
  • parasagittal frontal lobe

(is noted.)

Multiple Calcification

Ref: Multiple calcification

  • multiple scattered foci of calcifications in bilateral cerebral hemispheres, predominantly located along the gray-white matter junction.

IMPRESSION:

  • Multiple scattered foci of calcifications in bilateral cerebral hemispheres, likely representing sequelae of chronic granulomatous disease or calcified neurocysticercosis. Clinical correlation is required.

Chronic lesion

(Chronological change of ___, now seen as…)

encephalomalacia/gliosis change

  • (+) with volume loss, and

  • (+) associated ex-vacuo dilatation of the ___ ventricles.

IMPRESSION:

  • Sequelae of old traumatic contusion seen as encephalomalacia/gliosis change at ___ and associated ex-vacuo dilatation of ??? ventricles.

Hydrocephalus

{degree} = [mild | moderate | severe]

  • {degree} obstructive hydrocephalus as evidenced by {degree} dilatation of the ___ ventricle.

Ex-vacuole

{degree} ex-vacuole dilatation of the ??? horn of ___ lateral ventricle.

Evan’s Index

Ventricles: [No significant change] of hydrocephalus with Evans’ index of ___ (the prior CT study revealed Evan’s index of ???). No intraventricular hemorrhage.

IMPRESSION:

  • [No significant change] of (non-communicating) hydrocephalus with Evans’ index of ___.

Degeneration

Wallerian

Wallerian degeneration of the

  • {side} cerebral peduncle

is noted.

Tumor

Lipoma

  • A tiny well-defined hypodense lesion at parasagittal region of right paracentral lobule, probably representing interhemispheric lipoma

Post Op

  • Post-operative changes seen as ___

Post-Op Tumor (Bad)

History: … S/P craniotomy with tumor removal and decompression… He was sent to rule-out post-operative bleeding.

Findings: Limited evaluation of residual tumor due to lack of IV contrast.

The study reveals evidence of {side} {lobe} craniotomy for tumor removal and decompression with details of postoperative changes as follows:

(Collection)

  • Newly seen an evidence of air-blood-fluid collection in surgical cavity and extra-axial space of the ___ convexities (?? cm) with connection to subgaleal air-fluid collection and scalp swelling at right frontoparietotemporal convexities, measuring about ? cm in maximal thickness.

(Edema + Pressure Effect)

  • Associated surrounding vasogenic edema of the ___ lobe adjacent to the surgical site is observed. Note is made of an increased pressure effect seen as ……

(Residual Tumor)

  • Suspected of residual tumor seen as an evidence of homogeneous hyperdense lesion involving ___

(Hydrocephalus)

  • ___ degree of obstructive hydrocephalus seen as ….. dilatation of the ….. ventricle.

IMPRESSION:

  1. New evidence of ___ craniotomy for decompression with tumor removal with postoperative changes as described above.

  2. Increased pressure effect with ___.

  3. Suspected the residual tumor seen as an evidence of ___

  4. No acute intracranial hemorrhage or acute large territorial infarction

Craniotomy

Evidence of ___ craniotomy is noted, (with VP shunt)

along with post-operative changes seen as

  • (+) dural thickening with calcification along ___

  • (+) (small) extradural fluid collection, measuring up to __ mm in maximal thickness.

  • (+) [Increased | Decreased] degree of scalp swelling and soft tissue gas along surgical site.

IMPRESSION:

  • Post ___ craniotomy, with post operative changes seen as dural thickening and calcification. (small) extradural fluid collection is still noted.

Dural Thickening / Calcify

No significant change of calcified dural thickening at the [lt | rt] cerebral convexity craniotomy site.

Burr hole

SDH s/p burr holes

  • air-fluid-blood: The study reveals new evidence of {location} burr holes for subdural clot irrigation, now leaving air-fluid-blood collection along the ___, measuring up to ?.

  • Pressure: Decreased pressure effect seen ___.

  • Scalp: Subgaleal collection and scalp edema along the both-sided head are observed, likely postoperative change.

Tube / Line

Enteric

  • Enteric tube via ___ nostril (without visualized its tips) is noted.

VP Shunt

Cerebral parenchyma and extra-axial spaces: ___ craniotomy with ventricular shunt via ??? approach, which the tip is at the ??? of ??? lateral ventricle abutting the ???.

IMPRESSION:

  • No change in position of [lt | rt] ventricular shunt with its tip in the ___ of ??? lateral ventricle.