Interpet CT scan
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CT Head Scan Interpretation
Video 1 - Sagittal View (Non-Contrast CT Head)
Technique: Non-contrast CT (NCCT), sagittal plane, brain window (soft tissue windowing).
Findings:
| Structure | Finding |
|---|---|
| Cerebral cortex | Sulci and gyri visible; mild prominence of sulci |
| Corpus callosum | Well-defined in midline |
| Ventricular system | Lateral, third, and fourth ventricles visible; mildly prominent but not abnormally dilated |
| Brainstem | Midbrain, pons, and medulla appear normal morphology |
| Cerebellum | Normal appearance |
| Sella/pituitary fossa | Bony structures intact |
| Calvarium | No obvious fractures |
| Frontal & sphenoid sinuses | Air-filled, clear - no opacification |
| Hemorrhage | None detected - no acute hyperdense areas |
| Infarct | None detected - no large hypodense acute territorial infarct |
| Mass effect | None |
Impression (Video 1):
- No acute intracranial pathology
- Mild cerebral atrophy - mild prominence of cerebral sulci and ventricles, consistent with age-related volume loss
Video 2 - Coronal Reconstruction (Non-Contrast CT Head)
Technique: Non-contrast CT (NCCT), coronal reconstruction, brain/soft tissue window.
Findings:
| Structure | Finding |
|---|---|
| Cerebral hemispheres | Symmetric bilaterally |
| Gray-white matter differentiation | Preserved throughout |
| Midline structures (falx, septum pellucidum) | Midline - no shift |
| Lateral, 3rd & 4th ventricles | Normal size and configuration; no hydrocephalus |
| Cerebral sulci & sylvian fissures | Patent, appropriate for age - no effacement |
| Basal cisterns | Patent |
| Extra-axial spaces | No subdural or epidural hematoma |
| Calvarium & skull base | Intact on soft tissue windows |
| Paranasal sinuses | Sphenoid, ethmoid, and maxillary sinuses well-aerated; no mucosal thickening or fluid levels |
| Hemorrhage | None detected |
| Mass / space-occupying lesion | None identified |
Impression (Video 2):
- Grossly unremarkable coronal CT of the brain
- No acute intracranial hemorrhage, no large territorial infarct, no mass effect, no midline shift, no hydrocephalus, no extra-axial collections
Summary
Both views together represent a non-contrast CT head study (sagittal + coronal reformats):
- No acute intracranial emergency identified (no hemorrhage, no herniation, no acute infarct, no mass)
- Mild cerebral atrophy is the only notable finding, consistent with aging
- Paranasal sinuses and visualized skull are intact
Clinical caveat: This interpretation is based on video recordings of a monitor, which limits resolution and the ability to adjust windowing. A board-certified radiologist reviewing the original DICOM dataset - including full axial series, bone windows, and all reconstructed planes - is required for a definitive diagnostic report. Clinical correlation is essential.
This patient presented with headache, vomiting for multiple times, visual problem Possibilities …?
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The CT appeared grossly normal (no hemorrhage, no obvious mass, mild atrophy), yet the patient has classic raised ICP symptoms. This combination is highly characteristic. Here is the full differential:
Clinical Correlation: Headache + Vomiting + Visual Problems + Normal/Near-Normal CT
The triad you describe - headache, repeated vomiting, and visual disturbance - is the classic presentation of raised intracranial pressure (ICP). The CT appeared grossly normal, which significantly shapes the differential.
Differential Diagnosis (Most to Least Likely)
1. Idiopathic Intracranial Hypertension (IIH) / Pseudotumor Cerebri ⭐ Top Consideration
- Raised ICP with a normal CT is the hallmark
- Classic triad: pulsatile headache + vomiting + visual disturbances (transient visual obscurations, blurred vision, diplopia from 6th CN palsy)
- Papilloedema on fundoscopy is the key sign
- Most common in obese women of reproductive age, but can occur in anyone
- CT may show slit-like ventricles or empty sella - subtle findings easily missed on video review
- Diagnosis confirmed by lumbar puncture (opening pressure > 25 cmH₂O, normal CSF composition)
- (Adams & Victor's Neurology; Harrison's 22E)
2. Early/Subtle Posterior Fossa Lesion (Missed on CT)
- Posterior fossa tumors (medulloblastoma, ependymoma, cerebellar astrocytoma, metastasis) classically cause obstructive hydrocephalus
- CT may miss small posterior fossa lesions due to beam hardening artifact from the dense petrous bones
- MRI with gadolinium is far superior - a normal CT does NOT rule this out
- Symptoms: headache (worse in morning), projectile vomiting, visual problems (diplopia, papilloedema)
- (Harrison's 22E: "may produce hydrocephalus and signs/symptoms of raised ICP including headache, vomiting, papilledema, visual loss, impaired upgaze, or palsy of the 6th CN")
3. Cerebral Venous Sinus Thrombosis (CVST)
- Classically presents with headache + vomiting + visual problems
- CT may be normal in 30% of cases - often misdiagnosed
- CT venography or MRI/MRV is required
- Look for: thunderclap headache onset, young women (on OCP), postpartum state, hypercoagulable states
- The "empty delta sign" on contrast CT (clot in superior sagittal sinus) is pathognomonic but often subtle
4. Subacute/Chronic Meningitis
- Persistent headache + vomiting + visual loss (via raised ICP/papilloedema or direct optic nerve involvement)
- CT often normal or shows only meningeal enhancement with contrast
- Causes: TB meningitis, cryptococcal meningitis, carcinomatous meningitis, fungal
- Lumbar puncture is diagnostic
- (Harrison's 22E: "obstruction of CSF pathways may produce hydrocephalus... headache, vomiting, papilledema, visual loss")
5. Cerebral Abscess (Early Stage)
- Can present with headache, vomiting, raised ICP
- CT without contrast or very early abscess may appear subtle
- Ring-enhancing lesion on contrast CT/MRI
- Usually fever, immunocompromised state, or source of infection (sinusitis, dental, cardiac)
6. Occult Subarachnoid Hemorrhage (SAH)
- Small or resolving SAH can appear normal on CT (sensitivity drops to ~85-90% after 24h)
- Thunderclap headache ("worst headache of life") + vomiting + visual symptoms (third nerve palsy = posterior communicating artery aneurysm)
- If suspected: CT angiography + LP (xanthochromia confirms SAH even with normal CT)
7. Migraine with Aura (if recurrent)
- Can cause visual aura + severe headache + vomiting
- CT would be normal
- Diagnosis of exclusion after ruling out structural causes
Immediate Next Steps Recommended
| Investigation | Rationale |
|---|---|
| Fundoscopy | Look for papilloedema (confirms raised ICP) |
| MRI brain with gadolinium | Superior to CT - detects posterior fossa lesions, venous thrombosis, meningitis, small tumors |
| MR venography (MRV) | Rule out CVST |
| Lumbar puncture (after imaging rules out mass) | Opening pressure, CSF analysis |
| CT with contrast (if MRI unavailable) | Ring enhancement, meningeal enhancement |
Summary
Given a normal/near-normal CT + headache + vomiting + visual symptoms, the most important diagnoses to actively exclude are:
- IIH (Pseudotumor Cerebri) - most likely if normal CT
- Posterior fossa lesion - CT misses these; get MRI
- CVST - requires MRV
- Meningitis (subacute/chronic) - requires LP
- Occult SAH - requires LP + CT angiography
Fundoscopy is the single most important bedside examination - the presence or absence of papilloedema will immediately guide the workup.
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