Presentation
Unconcious. Alleged motor vehicle accident.
Patient Data
A few tortuous vessel-like hyperdensities at the body of right lateral ventricle and hyperdense layerings at the occipital horn of right lateral ventricle, in keeping with acute intraventricular hemorrhage.
Subtle hyperdense thickenings of bilateral tentorium cerebelli represent acute subdural hematoma.
Large subgaleal heamtoma at bifrontal region.
Hyperdense fluid within the left maxillary and sphenoid sinuses.
Annotated images for the acute intraventricular hemorrhage.
Case Discussion
A case of severe traumatic brain injury - shear injury (diffuse axonal injury).
In the clinical history of significant traumatic mechanism with low GCS (most patients are intubated), a relatively normal CT brain should alert radiologists to look for serious pathology such as diffuse axonal injury at the back of our mind.
Although it is well known that CT brain is not sensitive to detect diffuse axonal injury, there are a few subtle signs for radiologists to suggest this diagnosis.
In this unfortunate case, the only telltale sign is the findings of isolated acute intraventricular hemorrhage in the lateral ventricle. This is enough for the radiologist to suggest shear injury for the clinician together with the poor/low GCS.
MRI brain (SWI/GRE sequences) is recommended for looking for other subtle microhemorrhage (e.g. at the corpus callosum, grey-white matter junction and brainstem).
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