Presentation
Toddler with a witnessed fall down the stairs. In the ER her GCS was between 3 and 7 and her right pupil was sluggish.
Patient Data
Age: 2 years
Gender: Female
From the case:
Vein of Trolard rupture
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Right mixed density subdural hematoma. There is a right to left midline shift and obliteration of the right lateral ventricle.
Gray/white differentiation is preserved.
There is a right occipital skull fracture.
This child was taken emergentily to OR where an acute and hyperacute subdural hematoma was evacuated. A torn right vein of Trolard was discovered.
Case Discussion
An acute subdural hematoma is not always found adjacent to the skull fracture site. A barely noticeable occipital fracture can have potent deleterious effects intracranially.