 BRAIN: There has been interval removal of right frontal intracranial pressure monitoring bolt. There has been evolution of multiple hemorrhagic contusions involving the bilateral frontal lobes, left larger than right, and anterior left temporal lobe with signal intensity consistent with a subacute hemorrhage. There is also high T2 signal surrounding the hemorrhages, suggestive of residual edema and perhaps gliosis, but with overall decreased associated rightward midline shift. There is no evidence of downward herniation. There is T1 and T2 hyperintense material along the tentorial leaflets and posterior falx cerebri that measures up to approximately 5 mm in thickness, compatible with subdural hematomas. There is also extra-axial hemorrhage overlying the right frontal convexity that measures up to 5 mm in width. There is a left parieto-occipital subgaleal hematoma that measures up to 10 mm. There is bilateral maxillary sinus mucosal thickening that is slightly increased. There is fluid within the bilateral mastoid air cells, sinonasal cavities, and upper aerodigestive track likely related to intubation and/or residual hemorrhage. Stigmata of multiple calvarial and maxillofacial fractures are evident, but better delineated on the prior CT.CERVICAL SPINE: The cervical spine alignment is anatomic. The vertebral bone marrow signal is unremarkable. The cervical and upper thoracic cord display normal signal characteristics. However, there is diffuse high T2 signal in the paraspinal soft tissue of the posterior craniocervical junction region. Otherwise, the major ligamentous structures appear to be grossly intact. There is a partially-imaged consolidation in the posterior right lung apex.
1.Extensive subacute hemorrhagic contusions involving the left greater than right anterior frontal lobes and left anterior temporal lobe with slight interval decrease in associated edema.2.Persistent subdural hemorrhage along the falx cerebri and tentorium and a right frontal convexity extra-axial hematoma.3.Stigmata of multiple calvarial and maxillofacial fractures are evident, but better delineated on the prior CT.4.Apparent mild paraspinal soft tissue edema in the posterior craniocervical junction region that may be related to a strain injury, but no evidence of acute fracture, ligamentous disruption, or spinal cord injury in the cervical spine.5.Partially-imaged right pulmonary atelectasias or contusion.