Radiological evaluation of head trauma by computer tomography in Ibadan, Nigeria

The computed tomography (CT) findings of 419 patients with head injury were reviewed. 254 (60.62%) showed abnormal CT findings while 165 (39.38%) had a normal CT examination. Pathological states, which were easily demonstrated by CT, include traumatic haemorrhages (i.e. intracerebral bleed 67 cases (26.3%), Subdural haematoma 73 cases (28.7%), cerebral oedema and other cerebral sequelae of trauma such as porencephalic cysts, cerebral infarction and leukodystrophy. Patients with focal neurological deficit showed more positive findings than those without. A total of 73 (17.42%) patients had fractures demonstrated on CT. 39 (23.2%) of the 168 patients with traumatic haemorrhages had associated fractures. Fractures were detected more in patients with intracerebral and epidural haemorrhages than subdural haemorrhages. Plain skull radiography alone is therefore not sufficiently valuable in investigating patients with head injury. Computed tomography, no doubt, offers an excellent method of investigating the patient with head injury in that it demonstrates intracranial or cerebral lesions that may or may not be associated with fractures; and which might be missed if CT is not done. CT examination should be obtained where it is available if clinical indication warrants it and when CT is to be done, plain films are irrelevant since CT with bone window settings and with 3D reformation would show fractures.