Haemorrhagic contusions

Case contributed by A.Prof Frank Gaillard

Presentation

Drunk. Fell. Hit head.

Patient Data

Age: 35 years
Gender: Male
CT

Traumatic haemorrhage is demonstrated within the floor of bilateral anterior cranial fossae with SDH, haemorrhagic cortical contusions and a small amount of SAH. Fractures through the roof of both orbits with depression of the right orbital roof fracture, which contacts the superior rectus muscle belly and bilateral orbital emphysema, but no orbital haematoma.

There is also shallow SDH within both middle cranial fossae, and with small amounts of SAH within the both temporal lobes. Ventricle size is within normal limits. No evidence of acute infarct.

There are transverse and longitudinal fractures through the right mastoid, with blood within the mastoid air cells. There is a transverse fracture through the right petrous temporal bone, which does not involve the otic capsule. There is also widening of the malleus-incus articulation. No definite involvement of the carotid canal. On the left, there is a transverse fracture through the mastoid, with no involvement of the otic capsule or disruption of the ossicles. Fracture extends up to the squamous temporal bone.

CT

CT scan 4 days later

There has been development of a large parenchymal haematoma within the floor of the left frontal lobe. This measures approximately 3.5 x 4 x 2.5 cm, and demonstrates surrounding low density / oedema. There is associated mass effect, with attenuation of the frontal horn of the left lateral ventricle and midline shift to the right of 6-7mm.

Case Discussion

One must always remember that CT scans are a snap-shot in time of what is often a dynamic / evolving process. As such a repeat scan can often demonstrate significant evolution. 
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Case information

rID: 24264
Case created: 4th Aug 2013
Last edited: 2nd Aug 2017
Inclusion in quiz mode: Included

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