Male, 3 months old, status post head trauma with intracranial hemorrhage, post evacuation of hematoma. MRI brain:Postoperative findings are seen compatible with right frontal convexity subdural hematoma evacuation. The underlying brain parenchyma is edematous and contains a few foci of parenchymal hemorrhage, but the previously seen local mass effect has largely been relieved. A relatively thin layer of subdural hemorrhage is seen along the remainder of the right cerebral hemisphere and to a lesser degree along the left posterior cerebral hemisphere. Sulcal T1 and FLAIR hyperintensity within the right cerebral hemisphere is seen which may reflect slow flow in the leptomeningeal vessels over perhaps trace subarachnoid blood product.Diffuse restricted diffusion is seen involving both cerebral hemispheres with slight relative sparing of the perirolandic tissues and the basal ganglia. The cerebellum is affected to a much lesser degree. There may be some crowding of sulci. However, no frank brain herniation is seen. The right lateral ventricle has reexpanded and the ventricular system is in general relatively normal in size.Brain MRV:No definite evidence of venous sinus thrombosis is seen. Postcontrast images demonstrate leptomeningeal enhancement in the right cerebral hemisphere.C-spine MRI:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No marrow edema is seen. The cervical ligamentous structures appear to be intact. There may be some mild posterior paraspinal edema in the upper neck. The spinal canal is not compromised and the spinal cord demonstrates normal signal intensity and morphology throughout. Mild expansion of the dorsal epidural space in the upper thoracic region is favored to represent prominence of the venous plexus.A large fluid collection is seen involving the fascial planes of the left neck extending into the mediastinum with associated rightward displacement of the airway. A left subclavian central venous catheter is in place. The left IJ vein demonstrates rim T1 hyperintensity which could reflect slow flow or partial thrombosis.
1.Evidence of subdural hematoma evacuation at the right frontal convexity. Thin residual subdural blood product is seen along the right cerebral hemisphere and to a lesser degree along the left cerebral hemisphere.2.Findings compatible with diffuse hypoxic ischemic injury of the cerebral hemispheres. Slight relative sparing of the perirolandic and basal ganglia structures is seen. The cerebellum is also affected but to a much lesser degree.3.No definite dural venous sinus thrombosis is seen.4.No evidence of acute posttraumatic cervical spine injury. Note is made, however, of a fluid collection extending from the left neck into the mediastinum with associated rightward displacement of the airway. This finding could reflect a hematoma or an effusion. Findings suggestive of slow flow or partial thrombosis of the left IJ vein are seen.Findings discussed with the pediatric ICU service at 12:45 PM on 11/9/16.