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Bifrontotemporal haemorrhagic contusions and extra-axial haemorrhage with moderate mass effect.
Large haemorrhagic contusions involve the inferior frontal lobes bilaterally as well as the anterior temporal poles, more extensive on right.
Extra-axial blood along the frontal and temporal convexities and anteriorly in the middle cranial fossa, to a maximal depth of 5 mm, likely a combination of subarachnoid and subdural blood. There is also a thin layer of parafalcine subdural haematoma and a small amount of traumatic subarachnoid blood in the sylvian fissures.
- Extensive skull, skull base, left petrous temporal and facial fractures as described below:
- An undisplaced fracture line extends along the right orbital roof and medial wall to reach the floor of the sphenoid sinus (which contains fluid), with possible involvement of the cribriform plate. The maxillary sinuses and ethmoid air cells are opacified with fluid, and irregularity of the intervening bone (superior aspects of medial walls of the maxillary sinuses) is suspicious for fracture.
- Undisplaced skull fracture extends in sagittal plane through the frontal bone in the midline, extending posteriorly in line with the sagittal suture, before curving to the left of the midline as it crosses the lambdoid suture into the occipital bone before crossing the left petrous temporal bones in longitudinal plane
- CT venogram may be performed to assess the venous sinuses, given fracture involvement of the sagittal suture and possibly sagittal sinus.