Presentation
Pedestrian hit by vehicle
Patient Data
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A 2.5 cm thick biconvex extradural hematoma overlying the right temporoparietal lobe is predominantly isodense but contains streaky high-density material within in a horizontal orientation emanating from the expected location of the middle meningeal artery. There is mass-effect with compression of the right temporal lobe, sulcal effacement in the right cerebral hemisphere, 9 mm midline shift to the left, mild compression of the right lateral ventricle and right-sided subfalcine herniation.
Small foci high attenuation in the right temporal lobe are suspicious for small petechial hemorrhages as well as subarachnoid hemorrhages.
No skull vault or skull base fracture is seen, but there is a scalp hematoma and wound overlying the right skull.
Case Discussion
It is important to remember that hyperacute hemorrhage is isodense to intravascular blood. In this case there are areas of clot retraction anteriorly. Other causes of a swirled or low density extradural hematoma are presence of dural tear with admixing of CSF with blood, anticoagulants, and low hematocrit.
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