Introduction to CNS Imaging, Trauma

New Orleans Criteria in Minor Head Injury

CT Indicated If GCS = 15 Plus Any of Following

Headache

Vomiting

Patient > 60 years

Intoxication (drugs, alcohol)

Short-term memory deficits (anterograde amnesia)

Visible trauma above clavicles

Seizure

Thoracolumbar Injury Severity Score

Description Qualifier Points

Injury Mechanism

Compression

Simple 1

Lateral angulation > 15° 1

Burst 1

Translation/rotational 3

Distraction 4

Posterior Ligamentous Complex

Intact 0

Suspected/indeterminate for disruption 2

Injured 3

Neuro Status

Nerve root involvement 2

Cord, conus involvement (incomplete) 3

Cord, conus involvement (complete) 2

Cauda equina involvement 3

Score is a total of 3 components. Score ≤ 3 suggests nonoperative treatment, whereas score of 4 is indeterminate. Score ≥ 5 suggests operative treatment.

For injury mechanism, the worst level is used, and the injury is additive. An example is a distraction injury with burst without angulation is 1 (simple

compression) + 1 (burst) + 4 (distraction) = 6 points. Modified from Vaccaro AR et al: Reliability of a novel classification system for thoracolumbar injuries:

the Thoracolumbar Injury Severity Score. Spine (Phila Pa 1976). 31(11 Suppl):S62-9; discussion S104, 2006.

of the C2 body. Odontoid fractures are especially common in

elderly osteoporotic patients who experience falls.

Cervical spine fracture classification: Cervical spine fractures

are classified functionally, according to presumed mechanism

of injury. Cervical hyperflexion injuries range from simple

compression fractures and "clay shoveler fracture" (C7-T1

spinous process avulsion) to unstable injuries, such as

posterior ligament disruption with anterior subluxation,

bilateral interfacetal dislocation, and flexion teardrop fracture.

In cervical hyperflexion and rotation injury, unilateral facet

dislocation (± fracture) is common. Forward displacement of a

vertebra < 50% of the AP diameter of the body is typical. The

articular pillars are fractured in hyperextension with rotation

injury.

Cervical vertical compression injury can cause a Jefferson

fracture. In cervical "burst" fractures, there is middle column

involvement with bony retropulsion.

Thoracolumbar fracture classification: Multiple systems for

classifying thoracolumbar fractures have been developed. In

the increasingly popular thoracolumbar injury classification

and severity score (TLICS), injury mechanism, integrity of the

posterior ligamentous complex, and neurologic status are

each scored. The total number of TLICS points is then used to

guide treatment.

Selected References

1. Gordic S et al: Whole-body CT-based imaging algorithm for multiple trauma

patients: radiation dose and time to diagnosis. Br J Radiol.

88(1047):20140616, 2015

2. Mietto BS et al: Neurotrauma and inflammation: CNS and PNS responses.

Mediators Inflamm. 2015:251204, 2015

3. Readdy WJ et al: A review and update on the guidelines for the acute nonoperative management of cervical spinal cord injury. J Neurosurg Sci.

59(2):119-28, 2015

4. Furlow B: Computed tomography imaging of traumatic brain injury. Radiol

Technol. 84(3):273CT-94CT, 2013

Brain: Pathology-Based Diagnoses: Malformations,

Trauma, and Stroke

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