Closed head injury

Case contributed by Frank Gaillard
Diagnosis certain

Presentation

Pedestrian hit by car. Decreased consious state.

Patient Data

Age: 25 years
Gender: Male

CT brain

ct

An 11 mm left frontal subdural hematoma effaces the cortical sulci and results in 2 mm of subfalcine herniation. A smaller extra-axial hematoma anteriorly in the left middle cranial fossa measures 7 mm; this is likely a small venous epidural hematoma. 

Right temporal lobe hemorrhagic contusions are associated with sulcal subarachnoid blood and a thin (2 mm) subdural hematoma.

No intraventricular blood. No transtentorial or tonsillar herniation. Grey white matter differentiation is preserved, with no evidence of acute ischemia.

Case Discussion

In young patients, acute subdural hematomas are usually seen in the setting of significant head trauma, usually with associated hemorrhagic contusions.

In this case, we see the simultaneous presence of: 

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