0:00

This is a four-year-old child who was dropped

0:04

from a chair, and it is an example of a quite

0:09

unusual location for a collection of blood.

0:13

So we're looking at the sagittal T2-weighted scan of

0:17

this child, and what we see is that the patient has a

0:21

very strange lentiform collection, that is, biconvex

0:27

collection that is spanning from the posterior. It extends

0:32

above the posterior fossa, above the edge of the straight

0:35

sinus and tentorium into the, uh, space posteriorly.

0:41

You notice that there is some element of mass effect

0:43

because the cerebellar tonsil is just below the

0:47

level of the foramen magnum in this individual.

0:51

Let's look at this collection on the axial scans.

0:56

Here we have the axial scan.

0:57

We see that this is a lentiform collection

1:00

that is seen in the posterior fossa.

1:04

On the right side of the cerebellum, but in addition,

1:08

in the midline, there is another collection,

1:11

which is seen posterior to the venous sinus.

1:17

So this is the torcula horophylli, the venous

1:22

confluence, where the straight sinus is coming

1:25

in, and the transverse sinuses are going out.

1:32

And it also is the inferior most

1:34

aspect of the superior sagittal sinus.

1:38

Let's look at that on the sagittal scan.

1:40

You see this is the inferior aspect of the superior

1:44

sagittal sinus and the collection is going behind the sinus.

1:49

A collection behind the venous

1:51

sinus must be in the epidural space.

1:55

It's actually stripping the dura from the underlying

2:01

periosteum and collecting in the epidural space.

2:05

A collection of this type in this location implies that

2:10

there has been a violation of the dural venous sinus

2:14

and the blood is collecting posteriorly in the space

2:19

between the dura and the inner table of the calvarium.

2:24

So this is an example of an epidural hematoma, not

2:28

from arterial leakage, but from venous leakage.