CT Scan importance in the first eight hours of head injury


  • Mohammed Alfageeh Faculty of Surgery, Umm Al-Qura University, Al Qunfudhah, Saudi Arabia
  • Moneerah Bahran Department of Radiology, Maternity and Children Hospital, Mecca, Saudi Arabia
  • Sultan Albargi Department of Radiology, Security Forces Hospital, Mecca, Saudi Arabia
  • Ibrahim Althomali College of Medicine, Taif University, Taif, Saudi Arabia
  • Adnan Alzahrani College of Medicine, Taif University, Taif, Saudi Arabia
  • Amal Al-Buqaisi College of Medicine, University of Hail, Hail, Saudi Arabia
  • Mahdi Al-Ramadhan College of Medicine, Imam Abdulrahman Bin Faisal university, Dammam, Saudi Arabia
  • Abdullah Hussain College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
  • Abdullah Alghamdi College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
  • Khalid Alsuhaibani College of Medicine, Arabian Gulf University, Manama, Bahrain




CT brain, Early, Head injury, Traumatic brain injury


Traumatic brain injury following head injury is a major public health problem that can result in significant long-term morbidity and mortality among adults and children worldwide. Emergency brain imaging is necessary for individuals subjected to traumatic brain injury to early detect treatable conditions. Prompt neurosurgical management of treatable conditions can prevent further damage and secondary neurological deficits. This will subsequently improve the outcome and reduce long-term disability. Computed Tomography (CT) of the brain is the investigation of choice for assessment of patients with head injury due to its availability, advantages, and sensitivity for multiple lesions following head trauma. This article will review and discuss the importance of CT imaging in evaluating patients with traumatic brain injury, its advantages, limitations, and prognostic values.


Harvey LA, Close JC. Traumatic brain injury in older adults: characteristics, causes and consequences. Injury. 2012;43(11):1821-6.

Baguley IJ, Nott MT, Slewa-Younan S. Long-term mortality trends in functionally-dependent adults following severe traumatic-brain injury. Brain Injury. 2008;22(12):919-25.

Carney N, Totten AM, O'reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury. Neurosurgery. 2017;80(1):6-15.

Haddad SH, Arabi YM. Critical care management of severe traumatic brain injury in adults. Scand J Trauma, Resusc Emerg Med. 2012;20(1):12.

Bullock MR, Povlishock JT. Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, AANS/CNS Joint Section on Neurotrauma and Critical Care. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2007;24(suppl 1):S1-106.

Le TH, Stiver SI, Gean AD. Imaging Diagnosis of TBI. In: Traumatic Brain Injury. 2012:15-48.

Harburg L, McCormack E, Kenney K, Moore C, Yang K, Vos P et al. Reliability of the NINDS common data elements cranial tomography (CT) rating variables for traumatic brain injury (TBI). Brain injury. 2017;31(2):174-84.

Rutland-Brown W, Langlois JA, Thomas KE, Xi YL. Incidence of traumatic brain injury in the United States, 2003. J Head Trauma Rehabil. 2006;21(6):544-8.

Finklestein E, Corso P, Miller T. The Incidence and Economic Burdens of Injuries in the United States. J Epidemiol Community Health. 2007;61(10):926.

Holsinger T, Steffens DC, Phillips C, Helms MJ, Havlik RJ, Breitner JC et al. Head injury in early adulthood and the lifetime risk of depression. Arch General Psych. 2002;59(1):17-22.

Ripley DL, Pacheco K, Sherer M. Brain Injury Medicine: Principles and Practice. J Head Trauma Rehabil. 2007;22(6):413.

Hettle M. Review of Brain injury medicine. 2nd ed. Principles and practice. Brain Inj. 2013;27(13-14):1737.

Raj R, Brinck T, Skrifvars MB, Kivisaari R, Siironen J, Lefering R, et al. Validation of the revised injury severity classification score in patients with moderate-to-severe traumatic brain injury. Injury. 2015;46(1):86-93.

Majdan M, Mauritz W, Brazinova A, Rusnak M, Leitgeb J, Janciak I, et al. Severity and outcome of traumatic brain injuries (TBI) with different causes of injury. Brain Inj. 2011;25(9):797-805.

Slovarp L, Azuma T, Lapointe L. The effect of traumatic brain injury on sustained attention and working memory. Brain injury. 2012;26(1):48-57.

Gomez PA, Lobato RD, Boto GR, De la Lama A, Gonzalez PJ, de la Cruz J. Age and Outcome After Severe Head Injury. Acta Neurochir (Wien). 2000;142(4):373-80.

Rakier A, Guilburd JN, Soustiel JF, Zaaroor M, Feinsod M. Head injuries in the elderly. Brain Inj. 1995;9(2):187-94.

de la Plata CD, Hart T, Hammond FM, Frol AB, Hudak A, Harper CR, O'Neil-Pirozzi TM, Whyte J, Carlile M, Diaz-Arrastia R. Impact of age on long-term recovery from traumatic brain injury. Arch Physical Med Rehabil. 2008 ;89(5):896-903.

Stippler M, Holguin E, Nemoto E. Traumatic brain injury in elders. Ann Long-Term Care. 2012;20(5):41-6.

Lolli V, Pezzullo M, Delpierre I, Sadeghi N. MDCT imaging of traumatic brain injury. Br J Radiol. 2016;89(1061).

Coles JP. Imaging after brain injury. Br J Anaesth. 2007;99(1):49-60.

Zee CS, Go JL. CT of head trauma. Neuroimaging Clin N Am. 1998;8(3):525-39.

Noguchi K, Ogawa T, Seto H, Inugami A, Hadeishi H, Fujita H, et al. Subacute and chronic subarachnoid hemorrhage: diagnosis with fluid-attenuated inversion-recovery MR imaging. Radiology. 1997;203(1):257-62.

Masters SJ. Evaluation of head trauma: efficacy of skull films. American Journal of Roentgenology. 1980;135(3):539-47.

Gentry LR, Godersky JC, Thompson B, Dunn VD. Prospective comparative study of intermediate-field MR and CT in the evaluation of closed head trauma. Am J Roentgenol. 1988;150(3):673-82.

Orrison WW, Gentry LR, Stimac GK, Tarrel RM, Espinosa MC, et al. Blinded comparison of cranial CT and MR in closed head injury evaluation. Am J Neuroradiol. 1994;15(2):351-6.

Woodcock Jr RJ, Short J, Do HM, Jensen ME, Kallmes DF. Imaging of acute subarachnoid hemorrhage with a fluid-attenuated inversion recovery sequence in an animal model: comparison with non–contrast-enhanced CT. Am J Neuroradiol. 2001;22(9):1698-703.

Markl M, Leupold J. Gradient echo imaging. J Magn Reson Imaging. 2012;35(6):1274-89.

Gallagher CN, Cole J. Neuroimaging in trauma. Curr Opin Neurol. 2007;20(4):403-9.

Sharif-Alhoseini M, Khodadadi H, Chardoli M, Rahimi-Movaghar V. Indications for brain computed tomography scan after minor head injury. J Emerg Trauma Shock. 2011;4(4):472-476.

Miglietta MA, Bernstein MP. CT evaluation of frontodiagonal skull base fracture. J Trauma - Inj Infect Crit Care. 2006;60(3):684.

West OC, Mirvis SE, Shanmuganathan KA. Transsphenoid basilar skull fracture: CT patterns. Radiology. 1993;188(2):329-38.

Swartz JD. Temporal bone trauma. Semin Ultrasound CT MRI. 2001;22(3):219-28.

Jamal M, Court O, Barkun J. Swirl Sign. J Am Coll Surg. 2009;209(6):789.

Amin N, Aymat-Torrente A. Subdural Hematoma: a rare adverse complication from bone-anchored hearing sid placement. Otol Neurotol. 2017;38(3):360-3.

Effron D, Schmidt KL, Sharma A. Subdural hematoma. J Emerg Med. 2006;30(1):93-4.

Hinson HE, Hanley DF, Ziai WC. Management of Intraventricular Hemorrhage. Curr Neurol Neurosci Reports. 2010;10(2):73-82.

Kowalski RG, Weintraub A, Mellick D, Nakamura T, Gerber D, Harrison-Felix C. Intraventricular hemorrhage on early CT predicts poorer short-and long-term outcome in moderate to severe traumatic brain injury. Arch Physical Med Rehabil. 2015 1;96(10):e7.

Natalí Angulo Carvallo PP, Abello AL. Critical findings in neuroradiology. Switzerland: Springer, Cham;2016:13-19.






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