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Figure 5–3. Heterogeneity of severe traumatic brain injury (TBI) shown by computed tomography (CT) scans of six different patients with severe TBI, defined as a Glasgow Coma Scale score of <8.Highlighting the significant heterogeneity of pathological findings, CT scans represent patients with epidural hematomas (EDH), contusions and parenchymal hematomas (Contusion/Hematoma), diffuse axonal injury (DAI), subdural hematoma (SDH), subarachnoid hemorrhage and intraventricular hemorrhage (SAH/IVH), and diffuse brain swelling (Diffuse Swelling).Source. Reprinted from Saatman KE, Duhaime AC, Bullock R, et al: "Classification of Traumatic Brain Injury for Targeted Therapies." Journal of Neurotrauma 25:719–738, 2008. Used with permission of Mary Ann Liebert, Inc. Publishers.

Figure 5–4. Day-of-injury computed tomography (CT) compared with follow-up magnetic resonance imaging (MRI).The day-of-injury CT images (top row) are registered at the same level of the follow-up MR (T1 sequence) images obtained 2 years postinjury (bottom row). The CT demonstrates multiple hemorrhagic lesions scattered throughout the brain but particularly in the frontotemporal and periventricular regions. Also, note the size of the ventricle on acute imaging. Even though there is effacement of the ventricle because of trauma-induced intracranial edema, the ventricle can be used to estimate original pretrauma size and used to track changes over time. Ventricular dilation is readily apparent on the follow-up MRI, seen below each CT.

Figure 5–5. Computed tomography (CT) imaging from the same case in Figure 5–4, showing the day-of-injury hemorrhagic lesions (top row), compared with the chronic hemosiderin deposits seen on the gradient recalled echo sequence (bottom row) registered in the same orientation as the CT.

Figure 5–6. The day-of-injury (DOI) computed tomography (CT) scans from Figures 5–4 and 5–5 have been analyzed in 3-D space outlining the ventricle (aquamarine color) on the DOI (A, left) compared with the follow-up magnetic resonance imaging (MRI) on the right (B), performed 2 years postinjury.Note the obvious ventricular dilation, a sign of nonspecific parenchyma volume loss. The bottom left CT scan (C) shows the multiple hemorrhagic lesions in red as occurred on the DOI, identified by points of increased density as shown in Figures 5–4 and 5–5. Note their congregation in the frontotemporal and periventricular regions. Superimposed on the 3-D follow-up MRI (D) is the combination of white matter signal changes (shown in red) revealed on the fluid-attenuated inversion recovery sequence and the regions of hemosiderin deposition identified in the gradient recalled echo sequence (shown in yellow).

Figure 5–7. Sequential changes from traumatic brain injury.This is the same patient shown in Figures 5–4, 5–5, and 5–6. (A) Day-of-injury computed tomography (CT), but despite multiple hemorrhagic lesions the temporal horns can still be visualized. In contrast, but 2 years postinjury, prominent temporal horn dilation is evident, with associated hippocampal atrophy as shown in the T1 (B), T2 (C), and fluid-attenuated inversion-recovery (FLAIR) (D) image sequences. The FLAIR sequence (D) also demonstrates signal abnormalities in the left temporal lobe.
Table Reference Number
Table 5–1. Diagnostic categories of abnormalities visualized on CT scanning

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