Diffuse cerebral edema

Case contributed by Craig Hacking
Diagnosis certain


Motor vehicle collision, GCS 3

Patient Data

Age: 70 years
Gender: Female

Extensive subarachnoid hemorrhage within bilateral cerebral sulci (relatively symmetric), Sylvian fissures, interhemispheric fissure, basal cisterns and fourth ventricle. The cerebral sulci are effaced.

Subdural hematomas overlie bilateral cerebral hemispheres measuring up to 7 mm in maximal depth overlying the posterior parietal lobes. Blood also layering along the right tentorium cerebelli.

Extension of the cerebellar tonsils 10mm below the foramen magnum. Narrow ventricles likely due to raised intracranial pressure. Small locules of gas within the left middle cranial fossa.

Supratentorial grey-white differentiation is reduced but not completely absent and the brainstem is of relatively low attenuation compared with cerebellar parenchyma.


  • Extensive bilateral subarachnoid and subdural hemorrhage. Loss of grey-white differentiation, swelling and cerebellar tonsil herniation indicate diffuse cerebral edema.
  • Minimally displaced fracture within the occipital bone with extension into the left parietal bone. Small locules of intracranial gas and adjacent hemorrhage.

The CTA study demonstrates poor opacification of intracranial vasculature due to raised intracranial pressure. There is opacification of the right internal carotid artery and reduced opacification of the narrow caliber right M1. Minimal vascular opacification beyond this point on the right.

There is poor opacification of the left ICA from beyond the petrous segment of this vessel with markedly reduced opacification of the left MCA.

Co-dominant vertebral arteries. Very narrow caliber basilar artery. The cervical portions of the ICA opacify normally.

Case Discussion

This case shows the signs of diffuse cerebral edema.

Absence of intracranial flow on CTA is one of the imaging tests for determining brain death but should not be used in isolation.

The patient died two days later.

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