Traumatic brain injury resulting in brain death

Bilateral temporal bone fractures and intracranial hemorrhage mostly centered intraparenchymally within the frontal temporal lobes. There are further areas of subdural, extradural and subarachnoid hemorrhages throughout the brain. Evidence of sulcal effacement and narrowing of the basal cisterns.

Progression of the bifrontal and bitemporal intraparenchymal hematomas to moderate volume adjacent to the anterior cranial fossa floor.  The largest left frontal hematoma measures 34 mm (AP) x 17 mm (TV) x 10 mm (CC) and the right frontal lobe measuring 21 mm x 17 mm x 32 mm.

The layering of hemorrhage on the left tentorium in keeping with subdural hemorrhage maximally measuring 3 mm. Left temporal subdural hemorrhage measures 3 mm. 

Minor progression of the bilateral  hemispheric subdural hemorrhages.  No intraventricular hemorrhage redistribution.  However hemorrhage is present within the prepontine cisterns.
Progressive effacement of the cisterns is noted with no evidence of uncal or tonsillar herniation.

There is an interval increase in the size of the intraparenchymal hematomas of both of the frontal lobes. 

There is now a new small subdural hematoma over the clivus 

Still no evidence of transtentorial or cerebellar tonsillar herniation.

There is an absent intracranial perfusion and tracer uptake in keeping with brain death. Hot nose sign noted.