Skull fracture: subtle
Fall. Hit head. Unremitting headache.
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5 mm anterior left paramedian frontal lobe contusional hemorrhage.
Linear midline frontal bone fracture continuing posterior to the coronal suture as the sagittal suture.
The remainder of the intracranial appearances are normal.
Be attentive however under pressure or a rush one is in, to do an appropriate sequence review of a scan, including viewing in the appropriate windows.
For CT head in trauma a minimum of:
- normal brain windows
- normal bone windows
- 'Subdural windows' - this being manually windowed to assess for subtle blood.
If there is a subtle skull fracture often VRT images can make it really stand out as in this case and illustrate well to the clinician and patient alike the injury.
Occasionally the scout image is also very useful in making a subtle fracture obvious.