Slide #8 Epidural Hematoma Case A 32 y/o man presented to the ER after slipping on ice in his driveway. The patient fell backwards and hit his head on the ground. The patient got up and returned to his house and told his wife what had happened. After about 20 minutes of sitting the patient began complaining of a headache. Approximately one hour after the fall the patient became disoriented and obtunded. The patient's wife immediately called an ambulance, which brought him in to the ER. On arrival the patient was obtunded to the point that he could not answer or respond to questions. The CT on the left was taken shortly after arrival. Diagnosis: Epidural Hematoma On CT, epidural hematomas appear as well-defined, high attenuation lenticular or biconvex extra-axial collections. Associated mass effect with sulcal effacement and midline shift is frequently present. Overlying linear skull fractures can often be visualized on bone windows. If an epidural hematoma appears heterogeneous, containing irregular areas of lower attenuation, this can indicate active extravasation of fresh unclotted blood, requiring immediate surgical attention. Alternatively, areas of low attenuation can represent serum extruded from the clot.
Slide #9 CT of the head obtained without intravenous contrast enhancement shows a biconvex high-attenuation epidural hematoma adjacent to the right frontal lobe ( arrows ). The lesion extends superiorly to the level of the body of the lateral ventricle ( arrow )
Slide #10 and inferiorly to the roof of the right orbit (arrow). Mild mass effect is exerted on the subjacent brain parenchyma. A fracture is visible extending through the right side of frontal bone (arrow)
Slide #11 to the roof of the right orbit (arrow) with associated extracranial soft tissue swelling (arrow).
Slide #16 Subdural Hematoma Case: A 26 yo female presents to her family practice physician complaining of a headache that has persisted for over one month and sporadic blurry vision that has worsened over the last week. The headache is only slightly relieved with Ibuprofen and is worse when doing strenuous activity. The blurry vision comes and goes and can last minutes to hours when it is present. The neurologic and physical exams are normal except for some slight papilledema. The patient was then sent for a CT exam, the results of which are shown here. Diagnosis: Subdural Hematoma
Slide #17 Axial CT images of the brain show a large isodense right-sided subdural hematoma ( short arrows ) extending from the high convexities to the low frontal lobe. It is producing extensive right to left midline shift with subfalcine ( arrow )
Slide #18 and right uncal (arrow) herniation. There is trapping of the ventricles and left temporal horn with acute ependymal cerebrospinal fluid seepage, predominantly in the left periatrial and occipital regions (long arrow).
