Diagnosis: Unspecified fallClinical question: change SDHSigns and Symptoms: SDH MRI brain:There is a right frontal lobe hemorrhagic focus present associated with fluid fluid levels and surrounding vasogenic edema. The hemorrhage measures approximately 21 x 30 mm axial dimensions. It is associated with susceptibility effect. There is subarachnoid distribution of susceptibility effect along the convexities present suggestive of siderosis. A small amount of intraventricular susceptibility effect layers in the occipital horns of the lateral ventricles left more than rightThere is a right-sided subdural collection present which measures 10 mm in thickness and is associated with mild mass effect. It extends to surround the right occipital lobe medially and laterally and is also adjacent to the right parietal lobe. There is approximately 4 mm shift of the septum pellucidum towards the left side. There are bilateral posterior fossa subdural collections present measuring up to 6mm thickness. There is no herniation appreciated.There are multiple punctate foci of susceptibility present in the subcortical and periventricular white matter.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the right maxillary sinus and opacification of ethmoid air cells and sphenoid sinuses.. The visualized portions of the mastoid air cells demonstrate opacification of the right mastoid air cells and middle ear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is signal change within the spinal cord at the C3 and C4 vertebral body levels. There is multilevel disc desiccation present.There is a mild superior endplate compression present at T3 associated with high T2 signal and low T1 signal in the adjacent vertebral body. There is no compromise to the spinal canal at this level. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is diffuse disc bulge associated with mild posterior ligamentous hypertrophy and bilateral uncovertebral osteophytes. There is effacement of spinal fluid ventral and posterior to the spinal cord at this level. Overall there is a moderate degree of spinal stenosis at this level. There is narrowing of the neural foramina bilaterally (right worse than left) at this level with some encroachment of right sided exiting nerve roots. There is associated T2 hyperintensity with low signal on T1 at the adjacent vertebral bodies neck to the endplatesAt C4-5 there is a diffuse disc bulge present associated with narrowing of the neural foramina bilaterally. There is partial effacement of spinal fluid ventral and to a lesser degree posterior to the spinal cord.At C5-6 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present at this level which narrow the neural foramina bilaterally.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There are bilateral uncovertebral osteophytes present at this level which narrow the neural foramina bilaterally.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.
1.There is a right sided subdural hematoma surrounding the right hemisphere associated with stable 5mm midline shift and mass effect on the right lateral ventricle.2.There is a right frontal intraparenchymal hematoma present.3.There is subarachnoid blood along the convexities of the right frontal and parietal lobes and in the right sylvian fissure.4.A small amount of intraventricular blood is present5.There are multiple microhemorrhages present in the periventricular and subcortical white matter. In the context of extensive hemorrhage elsewhere this is nonspecific.6.There is opacification of the right mastoid. No underlying fracture is identified, however, detection of a subtle fracture may require dedicated temporal bone imaging if it is clinically suspected.7.Cord signal change at the C3 and C4 vertebral body levels could be related to spinal stenosis at this level and represent spondylitic myelopathy but it is nonspecific and could be related to a different cause.8.There are multilevel degenerative changes present in the cervical spine worse at C3-4 where there is a moderate degree of spinal stenosis. There is neural foramen encroachment at other levels with encroachment of exiting nerve roots as detailed above. The cervical spine exam is somewhat compromised by motion artifact which may obscure subtle abnormalities.9.Mild T3 superior endplate compression with findings suggestive of subacute change