CT Brain Quiz 2

Question

A 74 year old woman is brought to emergency following a sudden collapse while at church.  She has facial bruising, has a headache and is irritable.  She has a history of a myocardial infarct and a transient ischaemic attack, and takes clopidogrel.

A CT brain is shown here.  Describe the findings

ANSWER

This is a non-contrast CT of the brain and face.

There is a subdural haematoma overlying the convexity of the left hemisphere measuring almost a centimetre in depth at its greatest.  The haematoma also extends into the anterior falx.  There is effacement of the left hemispheric sulci, and midline shift of 5 mm to the right is present suggesting parenchymal oedema is present.  However, there is no evidence of basal cistern compression or hemispheric herniation.

There is no parenchymal or subarachnoid haemorrhage, and no evidence of skull fracture on these windows.   However, there is significant soft tissue swelling around the left orbit suggesting haematoma.  There is a small haemorrhage behind the eye in the orbital sinus.  Blood is also seen within the maxillary sinus, suggestive of a fracture.  No definitive fracture can be seen on these views, so careful review of bone window images is required.  

 

Summary

Left subdural haemorrhage, with midline shift of 5 mm towards the right.

Likely left orbital/maxillary fracture.

 

Past QUizzes

Chest Xrays

Quiz 1 - Chest trauma

Quiz 2 - Fall from a bike

Quiz 3 - Hypoxia after intubation

Quiz 4 - Anatomical variant

Quiz 5 - Vomiting, fever and shortness of breath

Quiz 6 - Hypoxia after cardiac surgery

Abdominal Xrays

Quiz 1 - Fever and distension

CT Brain

Quiz 1 - Altered conscious state

CT Chest

Quiz 1 - Acute Chest pain

Biochemistry

Quiz 1 - Increasing weakness


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