10-week-old female with a history of nonaccidental trauma resulting in large subdural hematoma, parenchymal hemorrhage, and possibility of hypoxic ischemic follow-up. There are diffuse areas of T2 hyperintensity and gyriform T1 hyperintensity throughout much of the left cerebral hemisphere and in the right occipital and parietal lobe with areas of mild volume loss, particularly in the posterior portions of the cerebral hemispheres. There is diffusion restriction throughout the corpus callosum, along the left posterior internal capsule, and in the left temporal stem. The cerebellum and bilateral deep grey nuclei appear to be spared. There are predominantly T2 and T1 hyperintense subdural fluid collections with areas of more intermediate T1 and low T2 signal along the bilateral temporal and posterior cerebral and cerebellar convexities, which are unchanged in size. There is an underlying T1 hypointense and T2 hyperintense subdural collection along the rest of the left cerebral convexity. Likewise, there is unchanged prominence of the right frontal convexity subarachnoid spaces. There is unchanged 4 mm of rightward midline shift. The ventricles and basal cisterns are unchanged in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Extensive areas of infarction involving the left greater than right cerebral hemispheres, which are likely late subacute to chronic, with associated cortical laminar necrosis and early Wallerian degeneration throughout the corpus callosum, along the left posterior internal capsule, and in the left temporal stem. The distribution of the infarcts suggests a strangulation type of nan-accidental trauma and dedicated vascular imaging of the neck may be useful, if clinically warranted.2. Acute to early subacute subdural hematomas along the bilateral temporal and posterior cerebral and cerebellar convexities superimposed upon a chronic left subdural hematoma and enlargement of the subarachnoid spaces, which are unchanged and associated with mild midline shift to the right.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.