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Table 2 Checklist of brain CT reading in patients with suspected acute ischemic stroke

From: Brain computerized tomography reading in suspected acute ischemic stroke patients: what are essentials for medical students?

1. Check patient’s ID
2. Reading bone windows [13, 29]
 Identify skull fracture
 Identify skull destruction
 Identify skull mass lesion or osteoblastic lesion
3. Sequential reading from extra-axial to intra-axial [16]
4. Identify the image symmetry of the bilateral hemispheres
 Extra-axial lesions
  Epidural and subdural space [29]
  Interhemispheric fissure
  Sylvian fissure
  Ventricles
   Lateral ventricles
   Anterior and posterior horns of lateral ventricles
   Temporal horns of lateral ventricles
   Fourth ventricle
  Specific regions
   Cerebellopontine angle
   Sella lesion
  Vessels
   Hyperdense MCA sign [15]
   Hyperdense BA sign [14]
   Veins: Dense sinus signs of CVT [22]
  Orbital cavity (Ophthalmic vein enlargement, orbital mass) [17]
 Intra-axial lesion
  ACA territory
  PCA territory
  MCA territory, basal ganglia and thalamus [24]
  Borderzone areas [26]
   MCA-ACA border zone
   MCA-PCA border zone
  Temporal lobes
  Mass effect, mid-line shift, or herniation [25]
  Brain stem
   Mid-brain
   Pons
   Medulla
  Cerebellum: symmetry, hyperdensity, hypodensity of the cerebellar hemispheres.
5. Identify abnormal densities on brain CT [27, 28]
 Identify hyper-density lesions
  Hematoma density
  Physiological calcification density
 Identify low density lesions
  Very low density (CSF and old lesions)
  Low density (edematous lesion and recent infarcts)
 Identify heterogeneous density lesions
  Hematoma with blended sign [18], whirl sign [19], spot sign [21], or black hole sign [20]
  Low density mixed with hyper-density (hemorrhagic infarct)
 Identify mass-like lesions
 ABBBC (Air-Blood-Bone-Brain-CSF) mnemonic [30]
  1. ACA anterior cerebral artery, CSF cerebrospinal fluid, CT computerized tomography, CVT cerebral venous thrombosis, ID identification, MCA middle cerebral artery, PCA posterior cerebral artery