5-year-old female with unknown fall concern for NAT, requiring intubation at OSH with small left SDH with no mass effect on CT. Evaluate for DAI and other trauma. MRI brain:There is extensive cortically based restricted diffusion in the cerebral hemispheres, particularly involving the left greater than right frontoparietal, occipital and posterior temporal regions. There is relatively more symmetric extensive restricted diffusion involving the deep gray nuclei and brain stem, particularly the midbrain but also minimally the pons. Punctate foci of restricted diffusion in various areas including the splenium of the corpus callosum and fornix probably reflect additional areas of ischemic injury with shear injury a less likely consideration.Again seen is a stable trace left acute subdural hematoma with unchanged 3-5 mm of rightward midline shift and evidence of evolving small amount of subarachnoid hemorrhage along the left frontal lobe sulci. The ventricles are probably slightly reduced in caliber but patent. The basal cisterns are visualized and there is no frank herniation at this point. The major cerebral flow voids are intact. There is left maxillary sinus mucosal thickening.MRI C-spine:The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
Extensive diffuse anoxic ischemic injury, involving the left more than right cerebral cortices, and the bilateral deep gray nuclei and brainstem. There is no evidence of herniation.Stable evolving trace 3 mm left convexity subdural hematoma and minimal left frontal region subarachnoid hemorrhage.