Radiology Review

All-Terrain, No Control

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All-Terrain, No Control image

A 40-year-old man is brought to the emergency department (ED) with a suspected intracranial hemorrhage after being thrown off an all-terrain vehicle. He was reportedly riding the vehicle without a helmet when he somehow lost control; the accident itself was unwitnessed.

En route to the ED, he was reportedly confused but hemodynamically stable, with a Glasgow Coma Scale score of 13-14. He lost consciousness while in the CT scanner, requiring emergent intubation for airway protection.

When you arrive to assess him, you note an intubated male with stable vital signs. The pupils display slight anisocoria but equally react. The patient withdraws in all four extremities secondary to pain, with slight posturing.

Noncontrast CT of the head is obtained, a static image from which is shown. What is your impression?


All-Terrain, No Control image


The image shows a large, convex hyperdensity within the left parietal region. This is a textbook image of an acute epidural hematoma. There is considerable mass effect and evidence of left-to-right shift. Windowing shows an underlying fracture, which is typically associated with these types of hemorrhages.

There is also evidence of a right-side concave hyperdensity, consistent with an acute subdural hematoma. Typically, this is referred to as a contrecoup injury.

The patient was transported to the operating room for an emergent left craniotomy for epidural evacuation; he recovered uneventfully.

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