Blunt head trauma: waxing and waning neurologic exam, lack of consistent purposeful movements. There is a small gyriform area of high T2 signal in the left anterior inferior left frontal lobe. There is also a subcentimeter ovoid focus of high T2 signal and restricted diffusion within the midline of the splenium of the corpus callosum. The brainstem and cerebellum appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no gross intracranial hemorrhage, midline shift, or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is bilateral tympanomastoid fluid. There is mild right temporo-occipital scalp swelling, measuring up to 7 mm in thickness. There is diffuse sinonasal sinus mucosal thickening and secretions, some of which may be related to intubation.
1. Contusion of the left anterior inferior left frontal lobe and shearing axonal injury involving the splenium of the corpus callosum. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Small right scalp hematoma and bilateral tympanomastoid fluid which may represent effusions, cerebrospinal fluid leakage, or hemorrhage, perhaps related to an underlying temporal bone fracture. Dedicated temporal bone imaging may be useful for further evaluation.