Presentation
Assaulted with a hammer.
Patient Data
Right parietal depressed skull fracture is noted with an internal displacement of the medial table measuring 7 mm. There is an associated parenchymal hematoma measuring 16 mm and traumatic subarachnoid hemorrhage. There is a comminuted, depressed left frontal bone fracture, extending inferiorly through the left frontal sinus, along the roof of the left orbit into the left carotid siphon. There is approximately 11 mm of depression noted and a small amount of associated acute subdural hemorrhage. Moderate pneumocephalus is noted. Measured at septum pellucidum, the midline is central. The fourth ventricle and basal cisterns are not effaced. There is a fracture of the left nasal bone and the frontal process of the left maxilla. The fracture extends along the anteromedial aspect of the left maxilla as well as along the posterolateral wall. There is blood in the left maxillary and sphenoid sinus noted. There is a fracture of the left mandibular ramus and coronoid process. The lateral pterygoid on the left is fractured.
Case Discussion
This case illustrates extensive intracranial and facial bone inflicted injuries. Depressed skull fractures result in the bone of the skull vault being depressed inward into the cerebral parenchyma as a result of a high energy impact to the skull, in this case, a hammer.
The fracture of the left anterior cranial fossa extending to the carotid canal raises concerns for associated traumatic vascular injury and further correlation with a CT angiogram was recommended.
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