Reason: evaluate s/p bolt removal- evaluate for DAI History: TBI MRI brain:There are multiple foci of diffusion restriction with associated susceptibility effect consistent with intraparenchymal hemorrhage and associated edema at the gray-white junction. These foci are most prominent in the left frontal lobe but also involve the anterior and posterior right frontal lobe, medial left occipital lobe and left temporal lobe. There are additional adjacent smaller foci of susceptibility without restricted diffusion. Punctate foci of susceptibility are noted in the most dependent portion of the occipital horn suggestive of minimal intraventricular blood products.There is been interval removal of a right frontal approach intracranial pressure monitoring bolt. A trace right parieto-occipital subdural hematoma measures 3 mm in thickness and is unchanged from recent CTs. Multiple maxillofacial fractures, including the bilateral nasal bones, bilateral orbital floors, maxilla, bilateral pterygoid processes and bony nasal septum, are better evaluated on dedicated maxillofacial CT. There is increased T1 signal within the bilateral maxillary and ethmoid sinuses which likely represents blood products. There is also associated moderate mucosal thickening. Blood products and secretions are present within the nasal cavity and nasopharynx bilaterally. An orogastric tube is present.No hydrocephalus. No midline shift or evidence of herniation. The major cerebral flow voids are intact. Fluid is present in the mastoid air cells bilaterally which may be related to intubation. MRI cervical spine:The vertebral column alignment is within normal limits. There is a normal relationship of the dens with the arch of C1. Fragmentation of the dens as seen on prior CT likely represents incomplete ossification, as no abnormal T2 signal is present. No surrounding edema. Normal marrow signal. No abnormal signal within the visualized cord. No epidural hematoma. No significant spinal canal or neural foraminal stenosis at any level.
1.Multiple foci of intraparenchymal hemorrhage as described above, many of which are at the gray-white junction and suggestive of diffuse axonal injury. Mild associated edema without midline shift or herniation. Trace right subdural hematoma as seen before. Minimal blood products within the occipital horns of the lateral ventricles are also noted. 2.Multiple facial fractures are better evaluated on recent CT.3.No evidence of fracture or subluxation in the cervical spine. There is incomplete fusion of the dens as noted on prior CT and within normal limits for age. No evidence of epidural or paraspinous hematoma or ligamentous injury.