This is Barry Bellosis, one of the musculoskeletal radiology fellows at Stanford University. 17 year old with helmet to helmet contact with another player concerned for subdural hematoma In the setting of trauma with concern for subdural hematoma CT without contrast is the imaging modality of choice. The patient in this case presented with this CT head without contrast. Axial slices through the brain here showing hyperdensity along the right hemisphere of the cerebrum consistent with subdural hematoma as demonstrated by its chrysanthic shape. Additionally, there is some linear hyperdensity likely going through the sole side which may represent the subarachnoid component. This is in contrast to an epidural hematoma, which is usually lentiform in shape. Although not routinely used in the setting of evaluation for subdural hematoma, MRI could be performed if there is concern for more serious injuries such as diffuse axonal injury. The patient in this case presented with this MRI brain with T2 fat saturated images showing heterogeneous fluid collection along the right cerebral hemisphere consistent with subdural hematoma. The appearance of subdural hematoma in the brain depends on the age of the blood products. Typically, gradient echo imaging is used to assess for micro hemorrhages such as those seen in diffuse axonal injury and they can be very sensitive. Although not depicted on these images. On a different patient and the 69 year old patient who presents after a fall, the CT head without contrast demonstrates this extra axial chrysanthic hyperdense fluid collection overlying the left cerebral convexity consistent with subdural hematoma. As we can see, it does exert mass effect on the underlying brain parenchyma. This is also seen on our coronal imaging here showing this extra axial hyperdense fluid collection with mass effect on the underlying brain parenchyma. The midline shift is usually measured in millimeter as a perpendicular distance between a midline structure, usually the septum pellicidum, and a line designated as a midline. In this case, we measure from the anterior phallus to the posterior phallus and measuring the distance between the septum pellicidum and the designated midline. Brain contusion is a type of intracerebral hemorrhage that typically happens on certain areas of the brain. The typical pattern includes the anterior cranial fossa such as here, the temporal pole such as here, and it typically follows a coupe-countercoupe pattern. The brain contusion typically demonstrates hyperdensity centrally with surrounding hypodensity such as here consistent with surrounding edema.

2nd Edition, CASE 38

2nd Edition

Neurology

subdural hematoma

helmet-to-helmet hit

brain contusion

CT scan

MRI