Back to Head Trauma 03

CB1089

Case Images

View Images / Launch Visage

Case Notes

History

13 yo male with ATV accident (no helmet). Initially asymptomatic and shortly later had altered mental status and respiratory failure (intubated).

Exam

Prior Study

Bone window CT head and upper C-spine
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.

Dicom

 
View Reference Material
Section 1

Submit Findings

CB1089

Findings

MR flair or T2w spin echo

There are extraaxial or intraaxial, or intraventricular, blood products.

There is evidence of brain contusion(s) or evidence of concurrent hypoxic or hypoxic ischemic (HIE) event.

There is evidence of mass effect producing brain herniation(s).

There are multiple sites of punctate edema or microhemorrhage within the white matter and/or along the gray-white subcortical junction consistent with brain shear acceleration-deceleration injury.

There are multiple sites of punctate edema or microhemorrhage within the corpus callosum, centronuclear structures, or brainstem consistent with acceleration-deceleration microvascular injuries.

There is vasogenic edema (and likely microhemorrhage) along egress pathways or cortical veins or the deep thalamostriate veins indicating venous tether injuries.

There is evidence of abnormal fluid accumulation along the margin of any major artery suggesting para arterial hematoma without intimal dissection-(Denver type 1 arterial injury).

There is evidence of abnormal fluid signal along the margin of any major artery with evidence of intimal flap or pseudoaneurysm confirming traumatic arterial dissection.

There is cytogenic edema in a recognizable arterial perfusion zone consistent with stroke superimposed on the traumatic injuries.

There is abnormal MR flair signal within the lumen of any major cortical vein or dural sinus suggesting venous egress thrombosis.

There is evidence of ventriculomegaly with subependymal edema indicating hydrocephalus (likely caused by SAH, which may not be evident) or sequestered ventricles.

Other

There is evidence of concurrent abnormalities not likely related to recent brain injury.