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 years
Gender: Male

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

Bilateral frontal subdural hyperdense hemorrhages. Left subdural collection of mixed density in keeping with acute on subacute subdural hemorrhage. 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 hemorrhage.

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 intracranial pressure (ICP) remained high and the patient was not improving.

Right frontal intracranial bolt in situ.

Some resolution of previously documented hemorrhages, with surrounding cerebral edema. 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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