Wk 5, Case 3 - Review

Patient History
Patient with fall and suspected intracranial hemorrhage (ICH).

Findings
BRAIN FINDINGS:
Brain Parenchyma, extra-axial spaces and sulci: No significant change in size of the 8 mm intraparenchymal hemorrhage right inferior temporal lobe and 9 mm intraparenchymal hemorrhage in the inferior right frontal lobe. Grossly unchanged vasogenic edema surrounding the foci of intraparenchymal hemorrhage. No significant change in size of the mixed attenuation extra-axial hematoma containing few foci of scattered air measuring up to 1.3 cm in maximal thickness overlaying the posterior left occipital lobe and extending inferiorly across the posterior left tentorial leaflet along the dorsal surface of the left cerebellar hemisphere. No new or increasing intracranial hemorrhage is seen. No significant mass effect or midline shift. Basal cisterns are
patent.

Ventricles: Normal for age.

Paranasal Sinuses: Mild mucosal thickening again the maxillary sinuses. The rest of the paranasal sinuses without significant mucosal thickening or secretions.
Mastoid Sinuses: Unchanged moderate effusion in right mastoid air cells and. Decreased diffusion in the left middle ear cavity. No obvious mastoid/temporal bone fracture identified. Right mastoid air cells and middle ear cavities are patent.

Orbits: Normal.
Cranium and Bones: Unchanged alignment of the nondisplaced nondepressed fracture of the left parieto-occipital calvarium with extension into the left lambdoid suture.
Soft Tissues: Unchanged mild soft tissue edema and contusion in the posterior scalp.

CTA FINDINGS:
No flow limiting stenosis or aneurysm.
Intracranial ICAs: Patent bilaterally from the skull base to the carotid terminus.
MCAs: Normal bilaterally.
ACAs: Normal bilaterally.
ACom: Normal
Vertebral arteries: Normal to the confluence with the basilar artery.
Basilar artery: Normal.
PCAs: Normal bilaterally.

CTV FINDINGS:
Superior Sagittal Sinus: Normal.
Internal Cerebral Veins: Normal.
Vein of Galen: Normal.
Straight Sinus: Normal.
Confluence of Sinuses: Opacified.
Transverse Sinuses: Nonopacification of the left transverse sinus. The right transverse sinus is normal.
Sigmoid Sinuses: There is significant narrowing/nonopacification of the left sigmoid sinus. The right sigmoid sinus is patent.
Proximal Jugular Veins: The left proximal jugular vein is not opacified. The right proximal jugular vein appear normal.

Impressions
1. Foci of intraparenchymal hemorrhage in the right inferior temporal and right inferior frontal lobes.

2. Extra-axial hematomas overlying the left occipital lobe and left cerebellar hemisphere with foci of air. This is likely epidural in location based on the fact that it crosses the tentorium.

3. Nonopacification/significant narrowing of the left transverse and sigmoid sinuses adjacent to the left parieto-occipital skull fracture suggestive of dural venous sinus injury/thrombosis. The sinus may be traumatized itself.

4. Patent intracranial arteries without significant stenosis or filling defect.