Where are common areas to check for contusions on CT head?
Unsurprisingly, the areas that come into contact with bone are most at risk. In particular, the anterior horns of the temporal lobes are almost encased in bone between the anterior and middle cranial fossae and easily missed when scrolling through the head. They should be a review area for everyone!
Though the patient has obvious frontal collections and trauma, why would we need to look at the occiput and the back?
In head trauma, the concept of "contre-coup" injury is important. If there has been enough force to damage the brain when moving in one direction, when it hits the skull the energy can keep the brain moving in the opposite direction against the back of the skull.
No previous CT for comparison.
Multiple well defined hyperdensities in right frontal lobe, bilateral temporal lobes and left pareital lobe.
Bilateral frontal subdural hyperdense haemorrhages. Left subdural collection of mixed density in keeping with acute on subacute subdural haemorrhage. Subarachnoid blood also present.
Effacement of right lateral ventricle (adjacent to largest intraparenchymal bleed). Impression of frontal subfalcine displacement but other midline structures in normal position. Basal cisterns normal.
Mixed transverse and longitudinal left temporal bone fracture involving mastoid and external auditory canal. Hyperdense fluid in mastoid air spaces, middle ear and external ear canal in keeping with blood. No involvement of venous sinuses or jugular system.