Case Images
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
MR susceptibility (SWI)
Prior Study
Bone window CT head and upper C-spine1. 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.
MR flair & MR T2-w
1. There are multiple sites of brain contusion not evident on prior sequences, see above
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
