PNR Head 11a
History
15 yo M with trauma, skateboard injury
Major FindingsFrom outside-in:
- Left occipital scalp hematoma with underlying occipital skull fracture
- At contre-coup site, subtle small frontal contusions; these are incredibly subtle and easily missed, but become more prominent on subsequent exam 2 days later (CL1034)
- Left anterior temporal intraparenchymal hemorrhage; on subsequent exam (CL1034) there is also trace hemorrhage in the anterior right temporal lobe that is difficult to appreciate on initial exam
- Diffuse cerebral edema given effacement of sulci
Teaching Points
- Use your outside-in approach to check coup and contre-coup sites.
- Check your blind spots, especially anterior inferior frontal and temporal lobes and cerebellum.
- Windowing is key -- use a wider subdural window (Level: 70-100 HU; Window: 150-300 HU) to make blood products stand out
Accession: CL0673
Study description: CT Brain Without
