Presentation
Fall from a height.
Patient Data
CT obtained on admission (D0) demonstrates a right occipital scalp hematoma with no underlying fracture. Large bilateral frontal and temporal hemorrhagic contusions (contrecoup) with overlying traumatic subarachnoid hemorrhage. A small amount of subdural hemorrhage is also seen layering on the tentorium, particularly on the right.
A lucency through the left parietal bone on bone windows (contralateral to the scalp hematoma) looks to be an undisplaced fracture. It appears very similar to a vascular channel but does extend over too many slices. It heads towards, but does not reach, the petrous temporal bone. Unfortunately, I cannot locate multiplanar images to confirm this on other planes. Thanks to Dr MG for pointing this out to me.
CT obtained the next day (D1, 24hrs) demonstrates the development of bilateral subdural hygromas larger on the left. Edema is also more prominent around the hemorrhagic contusions. Blood is now seen redistributed over the convexity of the brain as well as refluxing into the ventricles, pooling in the occipital horns.
CT obtained the next day (D2, 48 hrs) demonstrates the conituned evolution of hemorrhages and enlargement of hygromas.
Movement degraded CT on day 4 again shows enlarging hygromas and resolving blood.
Case Discussion
This case illustrates the evolution of closed head injury with blood in the subdural, subarachnoid and intraventricular compartments. Subdural hygromas also noted as are cerebral contusions.
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