Presentation
Motor vehicle collision.
Patient Data
There are bifrontal parenchymal hematomas with overlying subdural hemorrhage, and likely small-volume convexity subarachnoid hemorrhage. The left subdural hemorrhage contains a hypodense component, which may indicate that the patient is anticoagulated, or a hyperacute stage of hemorrhage.
There is significant mass effect resulting in rightward midline shift and uncal herniation.
Additionally, there are complex facial and calvarial fractures that are not shown.
5 days later, there has been infarction of the left PCA territory, likely result of left PCA occlusion from the rightward uncal herniation.
A fluid level has developed within the left frontal hematoma, which is another feature of intracranial hemorrhage while anticoagulated.
Case Discussion
The most feared complication of herniation is territorial infarction. Here we have occlusion of the left PCA by the herniated uncus.
There are also fluid levels within the left frontal intraparenchymal and subdural hematomas, which suggest that this patient is likely on anticoagulation.
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