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2Brain

cerebral compartment can cause subfal-cine, transtentorial, or central herniation; vascular compromise; and ischemia.

CT findings in both traumatic and non-traumatic swelling include global sulcal eacement, small ventricles, and com-pressed perimesencephalic and suprasellar cisterns. In head trauma, swelling is usu-ally associated with other findings includ-ing extra-axial hematomas, contusions, subarachnoid hemorrhage, and ventricular trapping (Fig. 2.14).

◆Cerebral Swelling

Cerebral swelling may be due to traumatic injury or one of many nontraumatic etiolo-gies, including intracranial neoplasm, in-fection, various metabolic derangements, and hypoxic-anoxic injury.

In severe head trauma, cerebral tissue damage, often associated with systemic hypovolemia, hypoxia, and hypercarbia, disrupts normal cerebral autoregulation and leads to a toxic cycle of elevated in-tracranial pressure, ischemia, and further tissue damage. Swelling localized to one

Fig. 2.14a–fa,bTraumatic cerebral swelling. Small right frontal extra-axial hematoma and diuse traumatic subarach-noid hemorrhage. Global cisternal and sulcal eacement with poor gray-white dierentiation. Associated right frontal scalp soft tissue swelling, orbital roof fracture, intraorbital hematoma, and intraorbital air.

c,d Traumatic cerebral swelling in another patient. Poor gray-white dierentiation, sulcal and perimes-encephalic cisternal eacement, right frontal subacute subdural hematoma/hygroma, and traumatic con-vexity subarachnoid hemorrhage.

e,f Cerebral swelling due to anoxic injury. Complete loss of gray-white dierentiation. No visible sulci or cisterns.