Can diffuse axonal injury be excluded on CT Brain?
No. Greater than 30% of patients with a negative CT will have a positive MRI.
How are petrous temporal bone fractures classified?
Traditionally petrous temporal bone fractures were classified as either longitudinal (parallel to the long axis of the petrous ridge) or transverse (perpendicular to the petrous ridge). There is now newer system of classification which is more predictive of complications and classifies fractures as either sparing or violating the otic capsule. Otic capsule violating fractures course through the osseous labyrinth and are more commonly associated with complications such as sensorineural hearing loss, cerebrospinal fluid otorrhoea and facial nerve injury than otic capsule-sparing fractures.
Brain and Skull
- Scalp haematomas.
- Diffuse sulcal effacement. No hydrocephalus.
- Diffuse axonal injury (pons, body/splenium of corpus callosum).
- Small posterior falcine subdural.
- Subarachnoid haemorrhage.
- Small volume of intraventricular haemorrhage.
- Left temporal extradural haemorrhage and pneumocephalus.
- Right longitudinally-orientated petrous temporal bone fracture sparing the otic capsule with ossicular chain disruption, haemomastoid and extension into the external auditory meatus. There is also extension into the right parietal and occipital bones.
- Left parietal bone fracture extending through the mastoid air cells and petrous temporal bone into the external auditory meatus. Ossicular chain is intact. Otic capsule sparing.
- Left base of skull fracture extending into the clivus, sphenoid bone, left foramen lacerum and left carotid canal. Possible extension into the right carotid canal. Haemosphenoid.
- Fracture of the nasal septum.
- Hard palate fracture.
- Medial left maxillary antrum fracture.
- Gas from the base of skull fracture in the soft tissues of the face.
- Oral cavity packing material.
C-Spine
- ETT, NGT, Guedels.
- Subarachnoind blood in the superior cervical spine.
- Gas from the base of skull fractures.
- No cervical spine fracture.