Subarachnoid hemorrhage - traumatic

Case contributed by Aditya Shetty


Fall from a height. Injury to the head.

Patient Data

Age: young adult
Gender: Male

Plain axial CT scan reveals areas of blood density noted in the subarachnoid spaces involving the sulcal spaces, Sylvian fissures and all basal cisterns bilaterally.

This is suggestive of a subarachnoid hemorrhage.

Another area of blood density noted in the left inferior frontal region suggestive of a contusion.

This is a coup-contrecoup injury.

Bone window reveals a fracture of the right parieto-occiptal bone with a subgaleal hematoma surrounding it. Subgaleal hematoma also noted in the left temporal region.

Case Discussion

The differential diagnosis for high density in the subarachnoid space beside subarachnoid hemorrhage (most common) is:

  1. Pyogenic leptomeningitis
  2. Leakage of intravenous contrast into the basilar cisterns

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