Wk 5, Case 2 - Review

Patient History
Pedestrian struck. Only reacts to painful stimuli. GCS of 5.

Findings
There is curvilinear high density along the left aspect of the septum pellucidum with extension into the frontal horn of the left lateral ventricle, thought to represent or acute hemorrhage. No pathologic mass effect.

No CT evidence of transcortical infarction. Basal cisterns are preserved. Calvarium is intact.

Minimal left maxillary mucosal thickening. Remaining paranasal sinuses and mastoid air cells are clear.

Bilateral parietal scalp contusions and subcutaneous emphysema with scattered punctate hyperdensities noted in the left parietal scalp compatible with foreign bodies.

Impressions
Small curvilinear intraventricular hemorrhage in the left lateral ventricle.

No hydrocephalus. No additional hemorrhage or pathologic mass effect.

Biparietal scalp contusions with scattered punctate foreign bodies in the left parietal scalp

Findings
A punctate focus of hyperattenuation is now seen in the posterior left internal capsule adjacent to the thalamus (series 2 slice 18). This was not definitely present on the prior exam. This measures no more than about 2 mm, and the possibility that this could reflect noise is considered.

Blood products previously seen along the left aspect of the septum pellucidum now predominantly layer within the occipital horn of the left lateral ventricle. The overall volume of blood products does not appear significantly changed. The caliber and configuration of the supratentorial ventricular system is similar to the prior exam, an appropriate for the patient's age. No midline shift. The gray-white matter differentiation is preserved. The basal cisterns are patent.

The orbits are normal. The paranasal sinuses, mastoid air cells, and middle ear cavities are clear. Dental carious lesions, partially seen.

Bilateral parietal scalp contusions are present, with surgical staples over the left parietal scalp. Subcutaneous gas is present in the left parietal scalp, consistent with prior laceration. Bony calvarium intact.

Impressions
A punctate focus of hyperattenuation measuring about 2 mm is now present in the posterior left internal capsule compared to the prior exam, may likely be artifactual, although tiny microhemorrhage is possible. Attention on follow-up exam. MRI would be more sensitive for parenchymal microhemorrhages if indicated.

Layering blood within the left lateral ventricle, without appreciable change in volume compared to the prior exam. Bilateral scalp contusions, similar to the prior exam.