Emergency Radiology of the Head and Spine

Preface
Contents
Part I: Brain: Traumatic Emergent Injuries (M. Muto, IT – P Vilela, Portugal – S. Wirth, DE)
	Imaging of Cranial and Facial Fractures
		1	 Introduction
		2	 Cranium
			2.1	 Calvarium
			2.2	 Imaging Techniques
			2.3	 Cranial Fractures and Imaging Features
		3	 Temporal Bone
			3.1	 Anatomy
			3.2	 Fractures
		4	 Skull Base
			4.1	 Anatomy
			4.2	 Fracture
		5	 Orbita
			5.1	 Anatomy
			5.2	 Fracture
		6	 Maxillofacial Bones
			6.1	 General Information
			6.2	 Imaging Techniques
				6.2.1	 Radiography
				6.2.2	 CT
			6.3	 Frontal Sinus
				6.3.1	 Anatomy
				6.3.2	 Fracture
			6.4	 Nasal Bone
				6.4.1	 Anatomy
				6.4.2	 Fracture
			6.5	 Naso-Orbital-Ethmoid Fractures
				6.5.1	 Anatomy
				6.5.2	 Fracture
			6.6	 Zygomatic Bone
				6.6.1	 Anatomy
				6.6.2	 Fracture
			6.7	 Maxilla Fractures
				6.7.1	 Anatomy
				6.7.2	 Fracture
			6.8	 Palatine Bone
				6.8.1	 Anatomy
				6.8.2	 Fracture
			6.9	 Mandibular Fractures
				6.9.1	 Anatomy
				6.9.2	 Fracture
		7	 Conclusion
		References
	Traumatic Haemorrhage
		1	 Extra-Axial Traumatic Haemorrhage
			1.1	 Epidemiology
			1.2	 Biomechanics
			1.3	 Types of Injury
				1.3.1	 Epidural Bleeding
				1.3.2	 Subdural Bleeding
				1.3.3	 Subarachnoidal Bleeding
		2	 Intra-Axial Traumatic Haemorrhage
			2.1	 Epidemiology
			2.2	 Biomechanics
			2.3	 Types of Injury
				2.3.1	 Parenchymal Haemorrhage
				2.3.2	 Diffuse Axonal Injury
		3	 Secondary Complications and Impact of Anticoagulation
			3.1	 Secondary Complication
			3.2	 Impact of Anticoagulation
			3.3	 Anticoagulation Substances
				3.3.1	 Coumarins
				3.3.2	 Thrombocyte Aggregation Inhibitors
				3.3.3	 Direct Oral Anticoagulants
				3.3.4	 Heparins
			3.4	 Risk Discussion
				3.4.1	 Coumarins
				3.4.2	 Thrombocyte Aggregation Inhibitor
				3.4.3	 NOAK
				3.4.4	 Heparin
				3.4.5	 Haemorrhagic Progression
		4	 Conclusions
		References
	Non-Accidental Injuries
		1	 Introduction
		2	 Mechanism of Injury
		3	 Imaging Strategy in Abusive Head Trauma
			3.1	 The Skull Vault and External Soft Tissues
				3.1.1	 Normal Anatomy and Development
					3.1.1.1 Wormian Bones
					3.1.1.2 Accessory Sutures
					3.1.1.3 Skull Fractures
					3.1.1.4 Skull X-Ray
		4	 Meningeal Anatomy and Intracranial Haemorrhage
			4.1	 Meningeal Anatomy
		5	 Intracranial Haemorrhage
			5.1	 Extradural Haematoma
			5.2	 Subdural Haematoma
			5.3	 Subarachnoid Haemorrhage
			5.4	 Dating of Haemorrhage
			5.5	 Parenchymal Injury
			5.6	 Cerebral Contusions
			5.7	 Diffuse Axonal Injury
			5.8	 Hypoxic-Ischaemic Injury
				5.8.1	 Herniation
				5.8.2	 Retinal Haemorrhage
			5.9	 Differential Diagnoses
		6	 Conclusion
		References
Part II: Brain: Non-traumatic Emergent Injuries (C. Çalli, Turkey – R. Basilico, IT)
	Acute Stroke: Parenchymal and Vessel Imaging
		1	 Non-Contrast Computed Tomography
		2	 Computed Tomography Angiography
		3	 Computed Tomography Perfusion Imaging
		4	 Conventional Magnetic Resonance Imaging
		5	 Diffusion-Weighted Imaging
		6	 Susceptibility-Weighted Imaging (SWI)
		7	 Magnetic Resonance Angiography
		8	 Magnetic Resonance Perfusion
		References
	Acute Stroke: Management
		1	 Recent Data on Mechanical Thrombectomy
		2	 Indications of Mechanical Thrombectomy
		3	 Triage for Mechanical Thrombectomy
			3.1	 “Mothership” Vs “Drip and Ship”
			3.2	 Clinical Scores
			3.3	 Triage in Angiography Suite
			3.4	 Perspectives
		4	 Technique(S)
			4.1	 Stent Retriever or Aspiration Catheter?
			4.2	 Balloon Guiding Catheters
			4.3	 Combined Technique
		5	 Safety of Mechanical Thrombectomy
		6	 Effectiveness of Mechanical Thrombectomy
		7	 Questions Yet to be Answered
			7.1	 Is Intravenous Thrombolysis Still Necessary in Combination with Mechanical Thrombectomy?
			7.2	 Distal Occlusions
			7.3	 Basilar Artery Occlusions
			7.4	 Anesthesia for Mechanical Thrombectomy
		8	 Conclusion
		References
	Nontraumatic Intracranial Hemorrhage
		1	 Nontraumatic Intracranial Hemorrhage
		2	 Neuroimaging of ICH
			2.1	 Computed Tomography
			2.2	 Magnetic Resonance Imaging
			2.3	 Digital Subtraction Angiography
		3	 Causes of Nontraumatic Intracerebral Hemorrhage
			3.1	 Primary Nontraumatic Intracranial Hemorrhage
				3.1.1	 Hypertension
				3.1.2	 Cerebral Amyloid Angiopathy
			3.2	 Secondary Nontraumatic Intracranial Hemorrhage
				3.2.1	 Vascular Malformations
				3.2.2	 Venous Thrombosis
				3.2.3	 Nontraumatic Subarachnoid Hemorrhage
				3.2.4	 Coagulopathy
				3.2.5	 Neoplasm
				3.2.6	 Hemorrhagic Transformation of Ischemic Stroke
				3.2.7	 Vasculitis/Vasculopathy
				3.2.8	 Infection
				3.2.9	 Alcohol and Drugs
		References
	Emergent CNS Infections, Inflammations, and Tumors
		1	 Neuro-Oncologic Emergencies
			1.1	 Introduction
			1.2	 Edema and Cerebral Herniation
			1.3	 Hemorrhage
			1.4	 Hydrocephalus
			1.5	 Leptomeningeal Carcinomatosis
			1.6	 Spinal Cord Compression
			1.7	 Seizures and Status Epilepticus
			1.8	 Paraneoplastic Neurologic Emergencies
			1.9	 Meningitis–Encephalitis
			1.10	 Cerebrovascular Complications
			1.11	 Iatrogenic Neurologic Emergencies
		2	 CNS Infections
			2.1	 Introduction
			2.2	 Meningitis
			2.3	 Empyema
			2.4	 Viral Encephalitis
				2.4.1	 Herpes Simplex Encephalitis
				2.4.2	 Other Viral Encephalitis
				2.4.3	 Fungal Encephalitis
			2.5	 Cerebritis and Brain Abscesses
		References
	Toxic–Metabolic Encephalopathies
		1	 Introduction
		2	 Imaging
		3	 Diseases
			3.1	 Hypoglycemic Encephalopathy
			3.2	 Hyperglycemic Encephalopathy (Non-Ketotic Hyperglycemia)
			3.3	 Osmotic Myelinolysis (Central Pontine Myelinolysis, Extrapontine Myelinolysis)
			3.4	 Hepatic Encephalopathy (HE)
			3.5	 Wernicke Encephalopathy
			3.6	 Carbon Monoxide Poisoning
			3.7	 SMART (Stroke-like Migraine Attacks after Radiation Therapy) Syndrome
			3.8	 Subacute Combined Degeneration
			3.9	 Cerebral Fat Embolism
			3.10	 Mild Encephalopathy with Reversible Splenium Lesion (MERS)
			3.11	 Heroin
			3.12	 Cocaine Encephalopathy
			3.13	 Synthetic Drugs
			3.14	 Posterior Reversible Encephalopathy Syndrome (PRES)
			3.15	 Thrombotic Thrombocytopenic Purpura (TTP)/Hemolytic Uremic Syndrome (HUS)
			3.16	 Reversible Cerebral Vasoconstriction Syndrome (RCVS)
			3.17	 Mitochondrial Disorders
		References
	Herniation Syndromes
		1	 Herniation Syndromes
		2	 Neuroimaging of Herniation Syndromes
		3	 Anatomy
		4	 Intracranial Herniations
			4.1	 Subfalcine Herniation
			4.2	 Transtentorial Herniation
				4.2.1	 Descending Transtentorial Herniation
					4.2.1.1 Lateral Herniation
						Anterior (Uncal)
						Posterior (Parahippocampal)
					4.2.1.2 Central Herniation
				4.2.2	 Ascending Transtentorial Herniation
			4.3	 Tonsillar Herniation
			4.4	 Transsphenoidal (Transalar) Herniation
		5	 Extracranial Herniations
		6	 Intracranial Hypotension
		References
	Basic Neuro-Interventional Spine Procedures
		1	 Introduction
		2	 Pathophysiology of Spine Pain
		3	 Mini-invasive Treatment for Degenerative Spine Disease
			3.1	 Epidural Steroid Injection (ESI)
				3.1.1	 Indications
				3.1.2	 Contraindications
				3.1.3	 Imaging
				3.1.4	 Technique
				3.1.5	 Results
				3.1.6	 Side Effects
			3.2	 Disk Treatment
				3.2.1	 Indications
				3.2.2	 Contraindications
				3.2.3	 Imaging
				3.2.4	 Technique
					3.2.4.1 Oxygen-Ozone Therapy
					3.2.4.2 Mechanical Decompression
				3.2.5	 Results
				3.2.6	 Complications
			3.3	 Facet Treatment
				3.3.1	 Indication
				3.3.2	 Contraindication
				3.3.3	 Imaging
				3.3.4	 Technique
					3.3.4.1 Facet Joint Injection
					3.3.4.2 Facet Joint Denervation
					3.3.4.3 Facet Screwing
				3.3.5	 Results
				3.3.6	 Complications
			3.4	 Spine Spacer
				3.4.1	 Indications
				3.4.2	 Contraindications
				3.4.3	 Imaging
				3.4.4	 Technique
				3.4.5	 Results
				3.4.6	 Complications
			3.5	 Vertebroplasty (VP)
				3.5.1	 Indications
				3.5.2	 Contraindications
				3.5.3	 Imaging
				3.5.4	 Technique
				3.5.5	 Results
				3.5.6	 Complications
		4	 Percutaneous Treatment of Primary and Secondary Tumors
			4.1	 Introduction
			4.2	 Mini-invasive Treatment of Spine Metastasis
			4.3	 Osteoid Osteoma (O.O)
			4.4	 Vertebral Hemangioma
			4.5	 Aneurysmal Bone Cyst (ABC)
			4.6	 Osteoblastoma (OB)
		5	 Conclusions
		References
Part III: Spine: Traumatic Emergent Injuries (M. Scaglione, IT, J. Spraat & E. Dick, UK)
	Introduction: Traumatic Spinal Cord and Spine Injury. Stability and Instability Concepts
		1	 Injuries Can Be Stable or Unstable
		2	 Pathology
			2.1	 Subaxial Cervical Spine
			2.2	 Thoracolumbar Spine
		3	 Clinical Presentations
		4	 Treatment
		References
	Traumatic Emergent Injuries: Cranio-Cervical Junction
		1	 Introduction
		2	 Imaging Approach
		3	 Bone Injuries
			3.1	 Occipital Condyle Fractures
			3.2	 Atlas Fractures
			3.3	 Axis Fractures
				3.3.1	 Hangman’s Fractures
		4	 Ligamentous Injuries
			4.1	 Occipitocervical Dislocation
			4.2	 Transverse Atlantal Ligament Injury
		5	 Craniovertebral Junction Injuries in Children
		6	 Pitfalls
			6.1	 Technical Factors
			6.2	 Anatomical Factors
		7	 Conclusions
		References
	Cervical Spine Injury
		1	 Introduction
		2	 Classifications, Stability and Instability
		3	 Injury Patterns
			3.1	 Flexion
			3.2	 Burst
			3.3	 Hyperextension
			3.4	 Fracture-Dislocation and Hyperflexion-Rotation
			3.5	 Ligamentous Injury and Disc Herniation
			3.6	 Spinal Cord Injury
		4	 Imaging Modalities
			4.1	 Low-Risk Patients
			4.2	 High-Risk Patients
			4.3	 Infants
			4.4	 Neurological Impairment
		5	 Conclusion
		References
	Thoraco-Lumbar Spine
		1	 Introduction
		2	 Stability
		3	 Who, Where and How to Image
		4	 Imaging Evaluation on CT & MRI (Anderson 2010)
		5	 General Considerations
		6	 Classification Systems
			6.1	 Three Column Spine
				6.1.1	 Compression Fractures
				6.1.2	 Burst Fractures
				6.1.3	 Seat Belt–Type Fracture
				6.1.4	 Fracture Dislocation
			6.2	 TLICS (Thoracolumbar Injury Classification and Severity Score)
				6.2.1	 Morphology
					6.2.1.1 Compression Injuries
					6.2.1.2 Translation/Rotation Injuries
					6.2.1.3 Distraction Injuries
					6.2.1.4 Neurological Status
					6.2.1.5 Integrity of the Posterior Ligamentous Complex
					6.2.1.6 Understanding the PLC
			6.3	 Arbeitsgemeeinschaft fur Osteosynthesefragen/AO Classification
				6.3.1	 Type A
				6.3.2	 Type B
				6.3.3	 Type C
				6.3.4	 Modifiable Factors
		7	 Conclusion
		References
Part IV: Spine: Non-traumatic Emergent Injuries (J. Van Goethem, L. Van der Hauwe, Belgium – M. Thurnher, Austria)
	Spine: Non-traumatic Emergent Injuries. Introduction
		References
	Emergent Degenerative and Disc Diseases
		1	 Introduction
			1.1	 Discovertebral Complex
		2	 Aging of the Intervertebral Disc
		3	 Anular Fissures
		4	 Disc Displacement
			4.1	 Disc Bulging
			4.2	 Disc Herniation
		5	 Osteophyte Formation
		6	 Vertebral Endplate Changes
		7	 Degenerative Marrow Changes
		8	 Facet Joint Age-Related Changes
			8.1	 Facet Joint Syndrome
			8.2	 Synovial Cysts of the Facet Joints
		9	 Posterior Longitudinal Ligament and Ligament Flavum Changes
			9.1	 Posterior Longitudinal Ligament Changes
			9.2	 Ligamentum Flavum Hypertrophy and Cysts
		10	 Baastrup’s Disease
		11	 Degenerative Intervertebral Instability
			11.1	 Degenerative Spondylolisthesis
		12	 Degenerative Stenosis of the Spine
			12.1	 Degenerative Cervical Spinal Canal Stenosis
			12.2	 Foraminal Stenosis in the Cervical Spine
			12.3	 Degenerative Thoracic Spinal Canal Stenosis
			12.4	 Lumbar Spinal Canal Stenosis
			12.5	 Redundant Nerve Roots of the Cauda Equina
		13	 Epidural Lipomatosis
		14	 Conclusion
		References
	Vascular Injury of the Spinal Cord
		1	 Spinal Cord Infarction/Spinal Cord Ischemia
			1.1	 Definition of Entity and Clinical Highlights
			1.2	 Epidemiology/Demographics
			1.3	 Pathophysiology
			1.4	 Imaging Technique and Recommended Protocol
			1.5	 MRI Findings
			1.6	 Differential Diagnosis and Pitfalls
		2	 Spinal Arteriovenous Shunts
			2.1	 Definition of Entity and Clinical Highlights
			2.2	 Epidemiology/Demographics
			2.3	 Pathophysiology
			2.4	 Imaging Technique and Recommended Protocol
			2.5	 MR Imaging
			2.6	 Differential Diagnosis and Pitfalls
		3	 Spinal Hemorrhage
			3.1	 Definition of Entity and Clinical Highlights
			3.2	 Epidemiology/Demographics
			3.3	 Pathophysiology
			3.4	 Imaging Technique and Recommended Protocol
			3.5	 Differential Diagnosis and Pitfalls
		4	 Fibrocartilaginous Embolism
			4.1	 Definition of Entity and Clinical Highlights
			4.2	 Epidemiology/Demographics
			4.3	 Pathophysiology
			4.4	 Imaging Technique and Recommended Protocol
			4.5	 Differential Diagnosis and Pitfalls
		References
	Emergent Tumors and Infections of the Spinal Cord
		1	 Introduction
		2	 Clinics
		3	 Imaging
		4	 Spinal Tumors
			4.1	 Intramedullary Tumors
				4.1.1	 Ependymoma
				4.1.2	 Astrocytoma
				4.1.3	 Hemangioblastoma
				4.1.4	 Spinal Cord Metastases
				4.1.5	 Spinal Cord Cavernous Malformation
			4.2	 Intradural-Extramedullary Tumors
				4.2.1	 Schwannomas
				4.2.2	 Neurofibromas
				4.2.3	 Meningiomas
				4.2.4	 Hemangiopericytoma
				4.2.5	 Paraganglioma
				4.2.6	 Melanocytoma
				4.2.7	 Leptomeningeal Metastases
			4.3	 Epidural Tumors
				4.3.1	 Metastases
				4.3.2	 Lymphoma
				4.3.3	 Sarcoma
				4.3.4	 Chloroma
		5	 Spinal Infections
			5.1	 Spinal Cord Abscess/Myelitis
			5.2	 Spinal Epidural Asbcess
		References
	Myelitis and Myelopathies
		1	 Introduction
		2	 Imaging Approach
		3	 Inflammatory Disorders of the Spinal Cord
			3.1	 Transverse Myelitis
			3.2	 Multiple Sclerosis
			3.3	 Neuromyelitis Optica
			3.4	 Neuro-sarcoidosis
			3.5	 Guillan-Barré Syndrome
		4	 Metabolic and Toxic Affections of the Spinal Cord
			4.1	 Vitamin B12 Myelopathy
			4.2	 Diabetic Myelopathy
			4.3	 Hepatic Myelopathy
			4.4	 Iatrogenic Myelopathies
			4.5	 Accidental or Voluptuous Toxic-Related Myelopathies
		References
	Spinal Post-operative Complications
		1	 Introduction
		2	 Acute Complications
			2.1	 Vascular Complications
				2.1.1	 Spinal Cord Ischemia/Infarcts
				2.1.2	 Haematoma
			2.2	 Dural Tear
			2.3	 Misplacement of Surgical Devices
		3	 Delayed Complications
			3.1	 Spinal Infections
			3.2	 Arachnoiditis
			3.3	 Recurrent Disc Herniation
			3.4	 Complications Due to Hardware Failure
		References
	Basic Neuro-Interventional Therapeutic Approaches
		1	 Endovascular Treatment of Haemorrhagic Intracranial Aneurysms
			1.1	 Introduction
			1.2	 Factors Influencing Endovascular Approach
				1.2.1	 Aneurysm Shape
				1.2.2	 Aneurysm Size
				1.2.3	 Location
				1.2.4	 Thrombus Inside The Sac
			1.3	 Endovascular Treatments and Techniques
				1.3.1	 Coiling
				1.3.2	 Balloon-Assisted Coiling
				1.3.3	 Stent-Assisted Coiling
				1.3.4	 Intrasaccular Flow-Disruptors (WEB®)
				1.3.5	 Flow-Diverter Devices
		2	 Endovascular Treatment of Haemorrhagic Intracranial Arteriovenous Malformations
			2.1	 Introduction
			2.2	 Brain Arteriovenous Malformations
			2.3	 Dural Arteriovenous Fistulas (dAVF)
		3	 Endovascular Treatment of Acute Ischemic Stroke
			3.1	 Introduction
			3.2	 Selection Criteria
			3.3	 Endovascular Treatments and Techniques
				3.3.1	 Stent-retriever Thrombectomy
				3.3.2	 Thromboaspiration
		4	 Conclusion
		References
	Emergency Paediatric Head and Neck
		1	 Imaging Modalities in Paediatrics
			1.1	 Plain Film
			1.2	 CT/CTA
			1.3	 MRI
			1.4	 Points for Consideration
		2	 Traumatic Pathology
			2.1	 Head
			2.2	 Cervical Spine
		3	 Non-traumatic Pathology
			3.1	 Cerebrovascular Disease and Stroke
		4	 Non-traumatic Intracranial Haemorrhage
			4.1	 Germinal Matrix Haemorrhage (GMH)
			4.2	 Cavernous Malformation
			4.3	 Hypoxic Ischaemic Encephalopathy (HIE)
			4.4	 Hydrocephalus
		References
Part V: Emergencies of the Face and Neck (E. Dick, UK, M. Scaglione, IT)
	Neck Space Anatomy
		1	 Introduction
		2	 Suprahyoid Compartments
			2.1	 Overview
			2.2	 Submental and Submandibular Spaces
			2.3	 Masticator Space
			2.4	 Parotid Space
			2.5	 Pharyngeal Mucosal Space
			2.6	 Carotid Space
			2.7	 Retropharyngeal and Danger Spaces
			2.8	 Perivertebral Space
			2.9	 Parapharyngeal Space
		3	 Infrahyoid Compartments
			3.1	 Overview
			3.2	 Visceral Space
			3.3	 Anterior Cervical Space
			3.4	 Posterior Cervical Space
		4	 Oral Cavity
		5	 Summary
		References
	Traumatic and Non-traumatic Head and Neck Infections
		1	 Introduction
		2	 Rhinosinusitis
			2.1	 Acute Sinusitis
				2.1.1	 Complications of Acute Sinusitis
			2.2	 Fungal Sinusitis
		3	 Otological and Skull Base Infections
			3.1	 Acute Otitis Media and Uncomplicated Mastoiditis
			3.2	 Acute Infective Labyrinthitis
			3.3	 Coalescent Otomastoiditis
				3.3.1	 Complications of Otomastoiditis
			3.4	 Petrous Apicitis (Gradenigo Syndrome)
			3.5	 Necrotising Otitis Externa
		4	 Odontogenic Infections and Their Complications
			4.1	 Subperiosteal and Palatal Abscesses
			4.2	 Floor of Mouth and Submandibular Space Infections
			4.3	 Buccal Space or Masticator Space Infections
			4.4	 Osteomyelitis
		5	 Pharyngeal Mucosal Space Infections and Their Complications
			5.1	 Acute Supraglottitis and Epiglottitis
			5.2	 Tonsillitis
			5.3	 Peritonsillar abscess (Quinsy)
			5.4	 Deep Neck Space Abscesses
			5.5	 Internal Jugular Vein Septic Thrombophlebitis (Lemierre’s Syndrome)
			5.6	 Traumatic Injuries of The Hypopharynx and Cervical Oesophagus
		6	 Orbital Infections
			6.1	 Periorbital Cellulitis
			6.2	 Orbital Cellulitis
			6.3	 Acute Dacryocystitis and Dacroadenitis
		7	 Acute Salivary Gland Infections
		8	 Infected Congenital Cysts
		9	 Tuberculosis in The Head and Neck Region (Scrofula)
		10	 Traumatic Infections
		11	 Post-Operative Infections
		12	 Acute Suppurative Lymphadenitis
		13	 Other Acute Infections
			13.1	 Infections of Primary Head and Neck Tumours or Nodal Metastases
			13.2	 Facial Cellulitis and Necrotising Fasciitis
		14	 Summary
		References