Female, 11 years old, status post head injury, craniectomy. Brain:Right frontal scalp swelling is seen along with evidence of the recent craniectomy. The known right frontal bone fracture is not specifically visualized on MRI. Sequelae of prior left frontal ICP monitor are also seen.The right frontal parenchyma subjacent to the area of skull fracture demonstrates mild T2 and questionable mild restricted diffusion. Clear restricted diffusion is seen within the splenium of corpus callosum. There may also be a few additional punctate foci of restricted diffusion, for example along the right superior cerebellum.No evidence of significant generalized mass effect is seen. No abnormal extra-axial collections are detected. Several punctate foci of susceptibility are evident in the right frontal lobe compatible with microhemorrhage. The ventricular system is normal in size and morphology. The mastoid air cells are opacified.C-spine:Straightening of the cervical lordosis is likely positional. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen. The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural collections are observed. The prevertebral tissues are difficult to assess due to intubation. The posterior paraspinal musculature is edematous. In addition, there is edema along the inferior aspect of the nuchal ligament, as well as mild edema within some of the interspinous spaces. However, the ligaments of the craniocervical junction, the ALL, PLL and ligamenta flava all appear to be intact. The intervertebral discs are preserved. No significant compromise of the spinal canal or neural foramina is demonstrated.
1.Sequelae of right skull fracture and craniectomy are demonstrated.2.The frontal lobe parenchyma subjacent to the area of fracturing demonstrates edema with perhaps a minor component of cytotoxic edema. There is also evidence of subtle microhemorrhage. 3.Restricted diffusion is also seen in the splenium of corpus callosum which can indicate axonal shear injury. There may be a few additional foci of punctate restricted diffusion also indicating axonal injury.4.No evidence of injury to the spinal cord or the osseous cervical spine is seen. The posterior paraspinal musculature is edematous. In addition, there is edema suggesting strain or partial tearing along the inferior nuchal ligament and to a lesser degree within the interspinous spaces of the mid cervical spine.