Head injury (massive)

Case contributed by A.Prof Frank Gaillard

Presentation

Motor bike accident. No helmet.

Patient Data

Age: 25 years
Gender: Male
CT

A comminuted and markedly displaced fracture of the right frontal bone extending into the frontal sinuses and superior orbital margin with numerous bony fragments in the anterior cranial fossa embedded in the cerebral parenchyma is associated with extensive overlying scalp injury.

There is acute intra- and extra-axial haemorrhage in the anterior cranial fossa as well as small amounts of interventricular blood in the posterior horns of both lateral ventricles and in the cavum septum pellucidum. 

Additional fractures include:

  • vertical fracture through the right squamous temporal bone extending into the right petrous temporal bone and temporomandibular joint.
  • transverse fracture through the left frontal bone
  • longitudinal fracture throughthe left petrous temporal bone
  • right tripod fracture with involvement of the anterior and lateral walls of the right maxillary sinus, the right zygomatic arch and the lateralorbital wall
  • displaced fracture ofthe right lamina papyracea
  • undisplaced fractures through the left greater wing of sphenoid involving the left sphenoid sinus

The right tripod fracture leads to proptosis to the right eye and there isretro-orbital intraconal fat stranding in the right orbit. There is a congenital fusion defect of the posterior archof C1.

Case Discussion

A good example of why wearing a motorcycle helmet is a good idea. 

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Case information

rID: 36668
Case created: 4th May 2015
Last edited: 15th May 2017
Inclusion in quiz mode: Excluded

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