Traumatic contusion and subarachnoid hemorrhage

Clinical:

  • A 46 years old man
  • Involved in motor vehicle accident
  • History of loss of consciousness
  • Complains of headache and persitent vomiting
  • Clinical assessment in ED shows GCS 15/15, no neurological deficit
Axial non-contrast CT brain in axial plane

CT findings:

  • There are multiple hyperdense foci at left frontal and temporal lobe (yellow arrows).
  • The hyperdensities are of various sizes with minimal surrounding hypodensities.
  • There are hyperdensities along the cerebral sulci at left frontoparietal region (red arrow)
  • There is associated effacement of the cerebral sulci.
  • No midline shift, no internal brain herniation

Diagnosis: Traumatic brain injuries (cerebral contusion and subarachnoid hemorrhage)

Discussion:

  • Cerebral contusion also known as brain bruise occurs due to closed head injury against inner surfaces of the skull at the time of impact
  • Usually at contrecoup site of the injury
  • Location of cerebral contusion is at anterior base frontal, temporal lobes
  • CT appearance show small, focal areas of petechial haemorrhage, peripherally located, multiple and can be bilateral. However CT scan can be normal, very subtle and/or odema on initial imaging.¬†Over time, about half of the contusions evolve and grow larger in size.
  • Traumatic subarachnoid hemorrhage (SAH) occurs in about 40% of patients with moderate to severe head injury is associated with a significant worse outcome
  • Nearly all cases of traumatic SAH have other lesions to suggest traumatic cause
  • CT findings of SAH is seen as linear areas of hyperdensities in the cerebral sulci and convexities, Sylvian fissures or basilar cisterns.¬†Subtle SAH can be seen at interpeduncular fossa.
Author: radhianahassan