MR flair & T2-w
Claim CME CreditPOINT OF CARE INFORMATION
This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
Learning Objectives
As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
CME Advisory Committee Disclosure:
Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
Continuing Medical Education Credit
Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CB1089-MR flair & T2-w
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CB1089-MR flair & T2-w
Case ReportHistory
Exam
Prior Study
1. Extensive fracture of the left facial bones, left orbital apex, left otomastoid, left greater & lesser sphenoid wings. There are inner bone table fractures of both frontal bones, both ethmoid bones and the roof of the left otomastoid bones.
Noncontrast head CT
1. Extensive fractures mainly involving the left face (i.e. LeFort-3 complex). There are bilateral frontal bone fractures and ethmoid fractures with inner table fracture, likely the source of the intracranial air. There is a transverse fracture of the left temporal bone. There are fractures involving the left orbital apex including a posterior ethmoid bone spicule in close proximity to the optic nerve.
2. There are left intraorbital injuries with retroconal hemorrhages, probable Tenon's space hematoma, and ocular proptosis without obvious tenting.
3. There is a 4-5 mm subdural hematoma within the left anterior temporal fossa extending laterally along the basilar and low convexity of the temporal lobe. The does not produce uncal herniation.
Noncontrast MR T1-w post contrast
1. The T1-w MR adds no additional information not supplied by the head CT.
Findings
MR flair & T2-w
The left temporal fossa subdural is evident and unchanged. There is a very small right parafalcine subdural hematoma in the parieto-occipital area of no apparent significance at this time.
There is evidence of parenchymal edema (non hemorrhagic contusions) in both frontopolar areas and in the left anterior temporal pole. Additionally, there is edema in the left basifrontal area, which demonstrated a linear hemorrhage on CT.
There is focal edema in the mesial globus pallidus, which follows the distribution of the mesial left M1 and ICA apex perforators. However, the flow related signal dropout in the left ICA and M1-MCA appear normal without evidence of dissection. Nevertheless, this finding consistent with a vascular (perforator) shear injury.
There is fluid and blood products within all the paranasal sinuses and left otomastoid air cells related to bone injuries.
T2-w sequence demonstrates optic hydrops consistent with raised intracranial pressure.
Impression
2. There is focal edema in the left mesial globus pallidus, consistent with a vascular perforator shear injury.
3. There is optic hydrops consistent with raised intracranial pressure.
