Extra-axial haemorrhages with skull fracture (teaching)

Case contributed by UoE Radiology

Presentation

Emergency admission. Head injury in motor vehicle collision (RTC).

Patient Data

Age: 70
Gender: Female

Multiple internal and external cranial injuries.

There is a large right sided soft tissue swelling over the right temporal bone (sub-galeal haematoma).

Underlying this, there is an acute right subdural haemorrhage, as well as blood in the subarachnoid spaces.

There is mild mass effect, and evidence of haemorrhagic contusions in the left inferior temporal lobe.

Annotated coronal CT image demonstrating the large extracranial haematoma, large acute subdural haemorrhage with active bleeding, and areas of subarachnoid haemorrhage and focal parenchymal haemorrhage.

3D reformatting of bone windows showing a fracture of the right temporal bone. This is overlying the extensive haemorrhages we know are underneath on the other CT images.

(The other bone windows are available in the original case).

Case Discussion

This case demonstrates multiple abnormalities including skull fracture and acute subdural haemorrhage. There are areas of low density within the subdural haemorrhage suggesting active bleeding.

Adjacent to the subdural are linear areas of high density that extend towards the midline. This is blood within the sulci - subarachnoid haemorrhage.

On the opposite side of the brain, there are focal areas of haemorrhage within the brain parenchyma - the brain has been smashed against the skull during deceleration causing injury on the opposite side to the collision.

The skull fracture is also associated with a large extracranial haematoma (subgaleal collection).

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Thanks to Dr David Cuete for originally uploading this case. It can be viewed here, along with the bone windows of the CT.

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Case information

rID: 34105
Case created: 4th Feb 2015
Last edited: 23rd Sep 2015
Inclusion in quiz mode: Included

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