Multiple cerebral contusions and temporal bone fracture

Case contributed by Dr Derek Smith

Presentation

Tonic-clonic seizure with head injury. GCS 6. Bleeding from left ear and epistaxis.

Patient Data

Age: 60
Gender: Male

No previous CT for comparison.

Multiple well defined hyperdensities in right frontal lobe, bilateral temporal lobes and left pareital lobe.

Bilateral frontal subdural hyperdense haemorrhages. Left subdural collection of mixed density in keeping with acute on subacute subdural haemorrhage. Subarachnoid blood also present.

Effacement of right lateral ventricle (adjacent to largest intraparenchymal bleed). Impression of frontal subfalcine displacement but other midline structures in normal position. Basal cisterns normal.

Mixed transverse and longitudinal left temporal bone fracture involving mastoid and external auditory canal. Hyperdense fluid in mastoid air spaces, middle ear and external ear canal in keeping with blood. No involvement of venous sinuses or jugular system.

The patient was deteriorating on the ward with increased seizure activity with decreased consciousness.

Progression of parenchymal contusions in frontal and temporal lobes and of frontal subdural haemorrhage.

Given the progression of the bleeds and the altered presentation, the patient was transferred to critical care and intracranial pressure was monitored by a bolt. Despite aggressive management, the ICP remained high and the patient was not improving.

Right frontal intracranial bolt in situ.

Some resolution of previously documented haemorrhages, with surrounding cerebral oedema. No significant changes in mass effect.

Case Discussion

These serial scans illustrate the progression of intracerebral bleeds in this case following traumatic brain injury.

Collateral history revealed a history of significant alcohol intake and previous seizures in the context of withdrawal.

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Case information

rID: 36667
Case created: 4th May 2015
Last edited: 4th Oct 2015
Inclusion in quiz mode: Included

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