A useful mnemonic which is used to read an emergency head CT scan is:
- Blood Can Be Very Bad
Mnemonic
Using a systematic approach will help to ensure that significant neuropathology will not be missed.
- B: blood
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C: cisterns
- look for the presence of blood, effacement and asymmetry in four key cisterns (perimesencephalic, suprasellar, quadrigeminal and Sylvian cisterns)
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B: brain
- look for asymmetry or effacement of the sulcal pattern, gray-white matter differentiation (including the insular ribbon sign), structural shifts and abnormal hypodensities (e.g. air, edema, fat) or hyperdensities (e.g. blood, calcification)
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V: ventricles
- look for intraventricular hemorrhage, ventricular effacement or shift and for hydrocephalus
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B: bone
- look for skull fractures (especially basal) on bone windows (soft tissue swelling, mastoid air cells and paranasal sinuses fluid in the setting of trauma should raise the possibility of a skull fracture; intracranial air means that the skull and the dura have been violated somewhere)