Presentation
Fall down 6 steps, intoxicated, blood from the right ear. ? ICH
Patient Data
Right cerebral convexity subdural hematoma, with associated sulcal subarachnoid blood. Soft tissue swelling at the vertex, with a temporal bone fracture extending through the mastoid part. This is longitudinal and otic capsule sparing, and although there is mastoid and middle ear opacification there is no apparent ossicular disruption.
On the left side, there are contrecoup hemorrhagic contusions in the inferior temporal lobe, as well as small foci of pneumocephalus. Although no left-sided fracture can be identified, there must be an occult left temporal fracture to allow communication from the middle ear / mastoid space on this side.
Case Discussion
Right-sided temporal bone fracture with associated subdural hematoma and subarachnoid hemorrhage. Contrecoup injury with hemorrhagic contusion but also suspected occult left temporal bone fracture.
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