Presentation
Drunk. Fell. Hit head.
Patient Data
Traumatic hemorrhage is demonstrated within the floor of bilateral anterior cranial fossae with SDH, hemorrhagic cortical contusions and a small amount of SAH. Fractures through the roof of both orbits with depression of the right orbital roof fracture, which contacts the superior rectus muscle belly and bilateral orbital emphysema, but no orbital hematoma.
There is also shallow SDH within both middle cranial fossae, and with small amounts of SAH within the both temporal lobes. Ventricle size is within normal limits. No evidence of acute infarct.
There are transverse and longitudinal fractures through the right mastoid, with blood within the mastoid air cells. There is a transverse fracture through the right petrous temporal bone, which does not involve the otic capsule. There is also widening of the malleus-incus articulation. No definite involvement of the carotid canal. On the left, there is a transverse fracture through the mastoid, with no involvement of the otic capsule or disruption of the ossicles. Fracture extends up to the squamous temporal bone.
There has been development of a large parenchymal hematoma within the floor of the left frontal lobe. This measures approximately 3.5 x 4 x 2.5 cm, and demonstrates surrounding low density / edema. There is associated mass effect, with attenuation of the frontal horn of the left lateral ventricle and midline shift to the right of 6-7mm.