Temporal bone fracture and contrecoup injury - subtle

Case contributed by Dr Balint Botz

Presentation

Sustained a fall, hit the right temporal region.

Patient Data

Age: 75 years
Gender: Male
  • A small hyperdense right temporal contusion and circumscribed high-density subdural collection are visible on the left, indicating a contrecoup injury. 
  • A minimally displaced right temporal fracture is visible on the right. 

Both findings are subtle and best seen in the coronal reconstructions. 

Annotated image

Key images

After an initial quick survey in the axial plane reveals no abnormality (as likely in this case) the more thorough review of the scan in all three planes is best conducted with the injury mechanism in mind. 

1. In this case, the site of impact (right temporal region) is known, and using a vital piece of information, a small subcutaneous hematoma can quickly be spotted (key image 1). 

2. Carefully scrutinizing this region the discrete but obvious temporal bone fracture is much easier to identify (key image 2).

3. Particular attention must be then paid to the opposite side due to the coup-contrecoup injury mechanism. With that in mind, the small temporal contusion and subdural bleeding are more easy to discover (key image 3).

Case Discussion

A typical presentation of a subtle coup-contrecoup injury, where the value of clinical details about the injury mechanism and site, and the need to scrutinize both brain and bone window reconstructions in all three planes are demonstrated. 

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Case information

rID: 65705
Published: 19th Jan 2019
Last edited: 23rd Jan 2019
Inclusion in quiz mode: Included
Institution: University of Pécs

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