Presentation
Head injury while fighting. Couple of minutes LOC, vomiting ++ since. Ongoing headache and confusion.
Patient Data
Multiple traumatic injuries.
Separate right frontal and parietal hemorrhagic contusions. Surface subdural blood over the right lateral frontal and inferior temporal lobes, with extension over the tentorium.
Coronal fracture extending through both parietal bones, crossing the sagittal suture. On rewindowing, a small vertex extradural hematoma is visible between the fracture and the superior sagittal sinus. No sinus hyperdensity or other unenhanced features to suggest the sinus is occluded.
Case Discussion
When a fracture at the vertex is identified, ensure that a careful assessment extradural hematoma is performed. Although these should not cross sutures or dural reflections, if the suture is disrupted by fracture, diastasis or surgery then the normal anatomical boundaries have been removed.