You will order a lot of head CTs. For many of your critically ill patients, you will be the first provider to see the pictures showing up on the CT scanner computer when you bring them down for a scan. Time shouldn’t be wasted relying on a radiologist to call you when you can identify a grossly obvious acute finding.

Head CT can be thought of as kind of an equivalent to Chest X-ray in the level of detail you can learn from it – it isn’t great, but you are going to see if there is something grossly abnormal. If you are looking for something more subtle, you have to consider doing an MRI.

Head CT is useful to look for the three H’s: Hydrocephalus, Hemorrhage, and Herniation. If you have a new focal neurologic finding, you can use a Head CT to look for an actionable cause with a quick exam.

Keep in mind you don’t need contrast to look for most head CT pathology – you really only use contrast if you want to do a CT angiogram to look for a clot or aneurysm.

This tutorial discusses Head CT and some pathology you can recognize. We don’t expect you to relearn neuroanatomy like you did first year -- don’t get bogged down on the details of neuroanatomy, just focus on the broad strokes here. The anatomy quiz at the end of the anatomy section will cover the really essential points we want you to know.

This UVa module has a great deal of information. For our purposes, please just review the Trauma section:

https://www.med-ed.virginia.edu/courses/rad/headct/trauma1.html

Fast forward to a few months from now.....

You are an intern on nightfloat, alone in the hospital. You see these patients with the head CT findings below – what is it and what do you do?

There are some acute and some not acute cases here… Before you come to the 11am lecture with the resident, review the practical cases and make your diagnosis.