 Good morning, everyone. My name is Dr. Aarosh Singh from Vardaman Mahavir Medical College and Subdivision Hospital, New Delhi. The topic of my oral paper presentation is CT engeography head evaluation of adult non-traumatic headache secondary to SAH on NCCT head. Aim to assess the efficacy of CT engeography in adult non-traumatic headache secondary to SAH. Introduction. An acute headache is one that has developed within the last few days, hours or even minutes. Painful cranial facial neuropathies, secondary headache disorders and primary headache disorders are the three main categories of headache according to the third edition of the international classification of the headache disorders. Secondary headaches are due to an underlying medical condition and need special attention and further neuroimaging workup. The snoop mnemonic may catch potentially life-threatening headaches. In the snoop mnemonic, the S stands for Systemic Science and Disorders and for Neurologic Symptoms. O is for new onset or change and patient greater than 50 years of age. O stands for onset and thunderclap presentation. P stands for papillodema pulsital tinnitus, positional provocation precipitated by exercise. According to ACR Appropriateness Criteria, the first imaging that is appropriate is a CT head without intravenous contrast. Further imaging is guided by the findings of non-contrast CT and neurological findings. The common entities that may present as acute headache in the emergency department are subarachnoid hemorrhage, intra-serial hemorrhage, vascular abnormalities like reversible cerebral visceral restriction syndrome, cerebral venous thrombosis, infections, meningitis, encephalitis, and brain abscess, senous tumors, primary or metastas. CT and geographic is increasingly used in patients with acute severe headache, to rule out vascular abnormalities and has been proven valuable in detecting and preserves. Methods, neuroimaging, all scans were performed using as low as reasonably achievable principle that is allara principle. The patients who had presented the SH as the predominant finding on incest CT head underwent CT and geographic head. CT and geographic head, spiral acquisition of CT and geographic head was carried out on Siemens somatom definition flash 256 slides CT scan. Spiral volumetric data was acquired from arch of aorta to vertex of skull and arterial and venous face was in bolus tracking technique after giving IV iodinated contest agent through automated injector. ROI is placed at arch of aorta and triggered when handed HUs reach. Arterial phase taken at 11 seconds after contest injection and venous phase taken at 2 minutes after contest injection. Results, total number of patients were 40, male to female ratio is 18 to 22, pattern of SH is diffused in 13 patients, interior in 14 patients, right in 6 patients, left in 6 patients and posterior in 1 patient. A headache type is as follows, hollow cranial in 35 patients, frontal in 5 patients. Associated findings on the incest CT head other than SH were IVH that is intraventricular hemorrhage in 9 patients, intravenous camel hemorrhage in 11 patients and hydrocephalus in 4 patients. The mean age of the patients was 49.15 years, the age of participants is from 27 to 68 years. Enrissum location that is arising from Acom artery in 16 patients, India cerebral artery in 4 patients, internal carotid artery in 9 patients and middle cerebral artery in 7 patients. Enrissum size, the size of the dome. The ranges are as follows, 2 to 4 mm in 17 patients, 4 to 6 mm in 11 patients, 6 to 8 mm in 5 patients, 0 to 2 mm in 1 patient and 10 to 12 mm in 2 patients. These results are tabulated as follows. The case 1 is a ruptured AV fistula. In the first figure, incest CT head axial sections, we can see a hyperdense intravenous camel hemorrhage shown by blue arrow with perillational edema in left frontal temporal location. In the second figure, we can see a hyperdense round lesion in left temporal convexity within surrounded by blood shown by black arrow. In the third figure, we can see a left middle meningeal artery. It is a branch of internal mexiline artery. It is a hypertrophied shown by blue arrow with enlargement of the left foremins binoculars. In the fourth figure, we can see a dural AV fistula seen with early venous drainage in the left basal venous lozenthal shown by yellow arrow. The large venous sac is lighted up on CT engine. The case 2 is a ruptured acomenosome. On the incest CT head, we can see SIH in inter hemispheric fissure basal systems perimizine catholic shown by blue arrow with mild hydrocephalus. On CT engine graphically, we can see a ruptured narrow neck acomenosome shown by dark blue arrow. My case 3 is a ruptured right MC aneurysm. On the incest CT head, we can see diffuse SIH along inter hemispheric fissure basal systems shown by blue arrow, predominantly located entirely. On CT engine graphically, we can see a contrast filled out arching at region of right MCA bifurcation confirming a ruptured aneurysm shown by yellow arrow. My case 4 is a ruptured left MC aneurysm. On the incest CT head, we can see SIH in inter hemispheric fissure basal systems left sylvan fissure shown by blue arrows along with intra ventricle hemorrhage shown by yellow arrow and intra pencomal hemorrhage and left frontotemporoverital region shown by grieha. On CT engine graphically, we can see a ruptured left MC aneurysm shown by blue arrow. Discussion. This prospective observational study was conducted on 40 adults aged greater than 18 years who presented to the emergency department with non-traumatic headache secondary to acetone incestia. Headache was more commonly explained by females than males. CT engine graphically, head was done on 40 patients who had presented less H on NCT head as their predominant finding. CT engine graphically, head was normal in 2 patients and 38 patients had positive findings. A majority of patients in emergency setting in this study were diagnosed to have a intracineal endosomes in arteriovenous malformation of fistula. Endosomes were detected in 36 patients. One patient had arteriovenous malformation and one patient had arteriovenous fistula. The sensitivity of CT engine graphically, head came out to be 95% in detecting intracineal vascular pathology. Retrospective study done by allowance at all on patients who presented in acute headache, indicating that abnormal NCT head is the strongest predictor for detecting abnormality on CT engine graphically in patients with acute headache. The spectrum CT engine graphically findings in this study were symptoms seen in 103 patients, cerebral venous thrombosis seen in 6 patients, arteriovenous malformation in 7 patients, dissection in 5 patients, ischemia in 3 patients, and reversible cerebral basal incision syndrome in 2 patients, and arteriovenous fistula in 2 patients. Others, heat at all on 1 to 18 patients presenting in non-traumatic as such found a normal CT engine graph in 17.9% of patients during 11-year period. Thus, this study showed that CT engine graphically head is a useful tool in the evaluation of patients presenting with at all non-traumatic headache secondary to SH in the emergency setting. These are the references.