Subdural hemorrhage and retinal hemorrhages. Suspicion of nonaccidental trauma. Assess for diffuse axonal injury. Brain:The anterior subdural collections overlying the frontal, parietal, and temporal lobes have slightly increased in size. On the coronal images, the maximum thickness on the left side is 12 mm compared to 6 mm previously while on the right it is 9 mm compared to 6 mm previously. These collections are only minimally more hyperintense than CSF on T2/FLAIR and T1 but they show scattered foci of T1 hyperintensity associated with susceptibility effect reflecting their hemorrhagic nature. They extend minimally along the anterior falx, with mild mass effect on the underlying frontal lobes. A more focal T1 hyperintense, T2 hypointense component is present just superficial to the left central sulcus and is associated with confluent susceptibility effect. This component has decreased in size/retracted and likely represents evolving clot. On coronal T2-weighted images, it now measures 22 mm x 12 mm compared to 26 mm x 11 mm. It causes minimal mass effect on the underlying brain.The thin posterior subdural collection overlying the parietal and occipital lobes as well as the posterior fossa are heterogeneous but only mildly T1 hyperintense. These do extend along the posterior aspect of the falx. Compared to the previous CT scan, this have undergone some redistribution but have not significantly changed in overall volume.There are tiny superficial foci of diffusion restriction in the anterior corpus callosal body and genu, probably reflecting shear injury. Some are associated with susceptibility effect. Foci along the paramedian vertex frontal lobe cortex may relate to the callosal areas of injury, or could represent blood products relating to gliding contusion.There is a larger superficial area of more confluent mild diffusion restriction with associated blurring of the gray-white matter differentiation on T2WI involving the inferior aspect of the posterior left temporal lobe and the adjacent occipital lobe. This is associated with curvilinear T1 hyperintensity as well as peripheral contrast enhancement that is more pronounced on the delayed imaging. There is no significant susceptibility in this location.There is no midline shift or herniation.There is mild fluid in the mastoid air cells bilaterally. There is questioned left optic nerve head elevation with enhancement and perhaps trace diffusion abnormality.Cervical spine:Cervical spinal alignment is anatomic. The vertebral bodies are preserved in height. There is no abnormal marrow signal. The discs are also preserved in height and signal. The paraspinal soft tissues show no significant edema. The spinal canal is preserved as well as the neural foramina. The spinal cord is normal. There is peripheral opacity in the right lower lobe's apical segment which is probably atelectatic.
1.Tiny foci of scattered diffusion restriction and susceptibility effect involving the corpus callosum are most probably related to shear injury (diffuse axonal injury pattern). Foci along the paramedian frontal lobe cortex could represent superimposed gliding contusions.2.A slightly larger and more confluent area of abnormality involving the peripheral posterior inferior left temporal lobe and adjacent occipital lobe is associated with peripheral contrast enhancement. The differential would include an evolving ischemic insult possibly venous and likely subacute given the associated contrast enhancement, minimally hemorrhagic contusion given mild T1 hyperintensity, and an area of postictal change if clinically applicable.3.Bilateral subdural collections are slightly larger than on the previous CT scan. They show foci of hemorrhage but are otherwise largely near CSF in intensity, suggesting greater chronicity. The more focal probable clot of the subdural hematoma which overlies the left central sulcus has retracted since the previous examination.4.The trace posterior fossa subdural collections are not significantly changed in overall volume though have undergone some redistribution compared to the previous CT scan. Stable trace more recent blood products within the dependent portions of the supratentorial collections.5.Questioned left optic nerve head elevation and enhancement. Please correlate with physical exam for papilledema.6.Unremarkable MRI of the cervical spine.