PNR Head 09

 Major Findings

• Right scalp/subgaleal hematoma with a nearby right occipital skull fracture 
• Arising from the skull fracture is an epidural hematoma, likely a venous epidural due with likely injury of the right transverse venous sinus 
• Multiple frontal hemorrhagic contusions 

 Teaching Points

• Use the outside-in approach for trauma cases (scalp --> skull --> brain parenchyma)
• Think of coup-contre-coup as a possible injury pattern
• The venous epidural hematoma contains different densities, suggestive of different age of blood products. Hypodensity does not always mean simple fluid -- it can indicate hyperacute blood products where blood has not yet clotted