Extra-axial hemorrhages with skull fracture (teaching)

Case contributed by UoE Radiology


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

Patient Data

Age: 70 years
Gender: Female

Multiple internal and external cranial injuries.

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

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

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

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

3D reformatting of bone windows showing a fracture of the right temporal bone. This is overlying the extensive hemorrhages 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 hemorrhage. There are areas of low density within the subdural hemorrhage 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 hemorrhage.

On the opposite side of the brain, there are focal areas of hemorrhage 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 hematoma (subgaleal collection).


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
Published: 4th Feb 2015
Last edited: 11th Sep 2019
Inclusion in quiz mode: Included