0:01

I'd like to look at this case initially

0:03

with the bone window sequences.

0:07

And what we see on the bone window sequences

0:09

is this large hematoma in the—of the calvarium,

0:15

and the skull, and the adjacent scalp.

0:19

And we see that there is a

0:21

laceration, which is extending

0:24

to the surface of the calvarium.

0:26

There is small little radiodensities here.

0:28

These may be foreign bodies.

0:30

Often, leaded glass will be hyperdense.

0:33

Occasionally, these little radiodensities are

0:36

actually pieces of the calvarium—little pieces of bone.

0:39

In this case, I don't really see a fracture.

0:42

And we're getting little specks here.

0:46

So this is likely gravel or leaded

0:49

glass or something in the scalp.

0:52

So this is our coup injury, right?

0:53

This is where the patient hit their head.

0:57

So we wanna look contracoup. On the

0:59

thin-section images of the CT scan,

1:03

we don't really see a hematoma contralateral.

1:08

We, we see actually another

1:09

area of scalp swelling

1:12

in the right parietal region, but looking at

1:15

the thick-section images probably would not

1:20

suggest any hemorrhage in the brain parenchyma.

1:25

However, you do see this little sliver of

1:29

hyperdensity along the septum pellucidum extending into

1:33

the frontal horn of the left lateral ventricle.

1:37

This indicates that there's likely an injury

1:41

to the septum pellucidum, and this extends

1:44

superiorly to the border with the corpus callosum.

1:47

If we go back to those thin-section images,

1:50

I just wanna point out one thing, and that is

1:53

that there is subtle layering of blood in the

1:59

occipital horns of the lateral ventricles.

2:02

This is this hyperdensity, and as I warned

2:05

you, residents, if you see some blood products—

2:09

just a little bit of blood in the occipital horn.

2:13

I'm talking about this little area here and this

2:15

little area here, representing small amounts of

2:20

blood products that are seen on the thin-section imaging,

2:27

an indicator of corpus callosum injury.

2:31

Usually the splenium of the corpus callosum. In this case,

2:36

injury to the septum pellucidum and its junction

2:39

with the top of the corpus callosum, having some blood products layering

2:43

into the occipital horns of the lateral ventricles.

2:47

This is an indication for diffuse axonal injury.

Case: DAI with Blood Products on CT

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