Presentation
Head contusion, left. Claims to have fallen and hit his head on a coffee table.
Patient Data
Left vertical temporoparietal fracture with a petrous temporal bone fracture component involving the otic capsule. Minimal malleoincudal joint dislocation (cf. contralateral auditory ossicles).
Left temporal epidural hematoma 10 mm thick. Right temporal contrecoup hemorrhagic contusion and subarachnoid hemorrhage. Subtle right tentorial subdural hematoma (best appreciated on coronal reformation). Thin extra-axial CSF-density collection anterior and superior to the left epidural hematoma - subdural hygroma most probably.
Bilateral middle ear-mastoid antral effusion, non-hemorrhagic (on left measuring 13 HU).
Substantial peripheral mucosal thickening in the right maxillary sinus.
Case Discussion
Head trauma resulting in four types of intracranial hemorrhage - epidural, subdural, subarachnoid, and hemorrhagic contusion. The epidural hematoma was caused by trauma to the middle meningeal artery or a branch thereof. A thin extra-axial collection aurrounding the epidural hematoma most probably represents a subdural hygroma.
It is quite obvious from the severity of the trauma that the patient was hiding the true nature of how he sustained the injury.
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