Traumatic subarachnoid hemorrhage - coup-contrecoup injury

Case contributed by Dr Henry Knipe

Presentation

Fall from standing height

Patient Data

Age: 80 years
Gender: Female

Subarachnoid hemorrhage in a left frontoparietal and right temporo-parieto-occipital distribution. Small volume of hemorrhage in the basal cisterns. Left tentorium cerebelli subdural hematoma measuring up to 3 mm. Ventricles, sulcal pattern and basal cisterns are age-appropriate. No skull fracture. Large left frontal subgaleal hematoma.

Conclusion:

Subarachnoid hemorrhage in a traumatic coup-contrecoup injury pattern.

Thin left tentorium cerebelli subdural hematoma.

Blue arrow = direction of the force

Yellow arrow = subarachnoid hemorrhage and subgaleal hematoma (coup injury, i.e. site of impact)

Red arrow = subarachnoid hemorrhage (contrecoup injury)

Case Discussion

Subsequent investigations did not reveal an aneurysmal cause. Coup-contrecoup injury patterns are common after a direct blow to the cranium. 

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