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Extradural hematoma, subdural hematomas, cerebral contusions and subgaleal hematoma

Case contributed by Assoc Prof Frank Gaillard

Presentation

Assault

Patient Data

Age: 55 years
Gender: Male

Non-contrast CT demonstrates a moderate left lateral convexity epidural hematoma, measuring 18 mm in maximal depth, associated with an undisplaced left temporoparietal fracture. Thin smear subdural hematomas are seen overlying the left and right temporal lobes, with further blood seen layering on the tentorium cerebelli on the right. 18 mm hemorrhagic contusion involving the left middle/superior temporal gyrus. Left parieto-occipital subgaleal hematoma.

Mild mass effect principally from the left epidural hematoma causes local sulcal effacement and approximately 4 mm of midline shift to the right. No hydrocephalus. Basal cisterns are within normal limits.

The left parietal bone fracture extends through the region of the pterion into the squamous temporal bone and along the floor of the middle cranial fossa, passing through the foramen spinosum and stopping just short of the internal carotid canal.

A fracture through the anterior maxillary wall and floor of the left orbit is also seen, involving the inferior orbital rim and inferior orbital canal. It extends through the lateral orbital wall with probable diastasis of both the sphenozygomatic and frontozygomatic sutures. 

Extradural hematoma (yellow dotted line) is associated with a linear fracture of the parietal bone (blue arrow). Note how the hematoma is bounded by the coronal suture (yellow arrow). Overlying subgaleal hematoma (orange dotted line) and a subjacent cerebral contusion ( * ). 

Small bilateral subdural hematomas are also noted (< and >) as well as blood layering on the right side of the tentorium (green arrow) seen as a vague region of increased density (easier to appreciate if coronal reformats were performed). 

Case Discussion

This case illustrates typical appearances of a significant closed head injury with a coup-contrecoup injury, the largest of which is a left-sided extradural hematoma (EDH). 

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