Wk 1, Case 2 - Review

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Report

Patient History
58-year-old female who presented with headaches and loss of consciousness.

CT head without contrast
Findings
These images demonstrate a large rounded area of hyperintense blood products seen emanating from the supraclinoid left side. This measures approximately 3.1 x 3.1 cm in size. There is subarachnoid hemorrhage. There is also subdural hematoma overlying the left hemispheric measuring approximately 8 mm in greatest dimension. There is subfalcine herniation and uncal herniation with shift of midline at the level of the septum pellucidum measuring 9 mm. Blood products also extend into the interhemispheric fissure and along the tentorium. There is dilatation of the temporal horn of the right lateral ventricle likely from mass effect and entrapment. The midbrain is deviated by the hematoma.The calvarium is unremarkable. Mastoid air cells and paranasal sinuses are clear.

Impressions
1. Rounded hematoma in the medial aspect of the left temporal lobe affecting being the uncus and communicating with the supraclinoid left side of the brain likely on the basis of aneurysm formation with hematoma. Extension into the subdural space of the left hemisphere and tentorium and interhemispheric parafalcine region raises the possibility of trauma.
2. Subfalcian and uncal herniation and right temporal horn dilatation.
3. Recommend CTA to assess for aneurysm versus conventional arteriography.

Case Discussion

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Joshua P Nickerson, MD

Associate Professor of Neuroradiology

Oregon Health & Science University

Francis Deng, MD

Assistant Professor of Radiology and Radiological Science

Johns Hopkins University School of Medicine

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Wk 1, Case 2 - Review