There is localized edema scalp along the left occiput extending anteriorly and superiorly to involve the parietal, periauricular and temporal regions. There is also soft tissue swelling in the left frontal and facial regions. The overall pattern of soft tissue injury is consistent with a primary injury to the occipital region with a contrecoup frontal injury.

There is a linear fracture through the squamous portion of the occipital bone on both sides with a more widely diastatic fracture extending through the basiocciput on the left.

There is an extra axial, likely, epidural hematoma and/or subdural along the floor of the posterior cranial fossa on the left and a clearly epidural hematoma associated with the left transverse sinus.

There are also hemorrhagic contusions in the right frontal and right temporal lobe as well as diffuse hemorrhagic contusions/DAI throughout the cerebellum, worse on the left than the right. Brainstem injury is confined mainly to the region of the inferior cerebellar peduncle and root entry zone of cranial nerves 7 and 8 on the left. The herniated cerebellar tonsils are edematous and hemorrhagic.

There is no definite subarachnoid blood identified.

There is hydrocephalus suggested by the enlargement of the temporal poles of the lateral ventricles, the ventricular system in general, as well as the generalized meningeal enhancement and posterior fossa mass effect seen most graphically on the sagittal T1-weighted post contrast images. This suggests at least the element of communicating hydrocephalus.

The right temporal bone is normal.

The external auditory canal shows minimal abnormal soft tissue thickening along its roof. There is middle ear or mastoid mucosal disease/fluid.

There is displaced petrous apex fracture involving the IAC, carotid canal and Eustachian tube. There is likely gross disruption of the facial nerve and both divisions of cranial nerve 8 with abnormal signal filling the internal auditory canal strongly suggestive of hemorrhage into those nerves extending to the root entry zone of cranial nerves 7 and 8 where there is obvious hemorrhagic brainstem contusion.

The facial canal is not obviously fractured but MRI cannot exclude fracture. However, there is clear evidence of injury to the facial nerve at the labyrinthine segment within the internal auditory canal.

There is no fracture crossing the transverse sinus. However, there is likely injury to the transverse sinus, resulting in an adjacent epidural hematoma.

There no definite fracture of the sphenoid bone or central skull base, so far as can be determined from MRI. There is, however, extensive mucosal thickening in the sphenoid sinus and posterior ethmoid sinuses with signal changes in the sphenoid sinus suggestive of blood in the sinus.

There is swelling present in the muscles of the masticator space and likely within the, both temporomandibular joint capsules more on the left than the right, and possible anterior dislocation of the articular discs.

There is no obvious bony injury or displacement of the any part of the of the mandible including the condylar head and fossa. The temporomandibular joints are slightly asymmetric with respect to their open position but not obviously injured.

The visualized portions of the cervical spine are normal for the patient’s age.