Findings
- Multifocal areas of supratentorial and infratentorial parenchymal T1 signal hyperintensity and susceptibility artifact, with the largest measuring 3 x 1.5 cm in the left frontal lobe
- Confluent area of T2/FLAIR hyperintensity in the inferior left temporal lobe
- Bilateral cerebral convexity mixed signal subdural collections with associated susceptibility artifact measuring up to 1 cm in thickness on the right and 0.7 cm in thickness on the left with trace susceptibility artifact along the interhemispheric falx
- Susceptibility artifact within bilateral cerebral sulci as well as layering in the right greater than left lateral ventricles
- Mild local mass effect without midline shift or evidence of hydrocephalus
- T2/FLAIR signal hyperintensity in the right dorsal pontomesencephalic junction and right superior cerebellar peduncle with associated susceptibility artifact and punctate diffusion signal hyperintensity
- Additional small foci of diffusion signal hyperintensity in the body and splenium of the corpus callosum, right lateral ventricle periventricular white matter, and left insula
- Heterogeneous T1 signal hyperintensity in the pituitary gland
- Right frontal approach intracranial pressure monitor
- Mucosal thickening of the paranasal sinuses with a small amount of layering fluid
- Fluid signal within right mastoid air cells
Diagnosis
Diffuse axonal injury (DAI), multicompartmental intracranial hemorrhage
Sample Report
Findings concerning for diffuse axonal injury (DAI) involving the dorsal midbrain and pons, right superior cerebellar peduncle, corpus callosum, periventricular white matter, and left insula with associated punctate hemorrhages and edema. Mild associated local mass effect without midline shift, herniation, or hydrocephalus.
Multicompartment acute intracranial hemorrhage including bilateral cerebral convexity hematohygromas with subdural hemorrhage tracking along the falx, bilateral frontal parenchymal hematomas, scattered small volume sulcal subarachnoid hemorrhage, and small volume intraventricular hemorrhage.
Traumatic contusion in the inferior left temporal lobe.
T1 hyperintense signal associated with pituitary gland may represent adjacent extra-axial blood products versus intraglandular hemorrhage. Recommend correlation with clinical or laboratory evidence of pituitary hypofunction.
Discussion