Clinical question: New bleed. Signs and symptoms cord status post fall, altered mental status. Non-enhanced CT brain: Images through posterior fossa demonstrate no definitive evidence of abnormality and stable since prior study.There is a focal area of edema involving the anterior tip of right temporal lobe (gray and white matter) with possible minimal hemorrhage which is similar to prior study. This results in effacement of adjacent cortical sulci. There is however no midline shift. This finding is concerning for a foci of contusion. Additional area of low attenuation involving the cortex and subcortical white matter of right frontal pole measuring 30-mm times 20 mm size. There is no detectable parenchymal hemorrhage in this region.Small amount of blood within the subarachnoid space in the right anterior parietal on axial image 21 is noted.There is a CSF density subdural hygroma which extends from approximately the level of the floor of the left anterior and middle cranial fossa superiorly to the vertex. There is interval increase in the size of these finding since prior exam. The thickest segment of this extra-axial CSF collection measures approximately 6 mm. There is resultant mild effacement of adjacent cortical sulci. A very small right sided frontal CSF density extra-axial collection is also suspected. This finding was present on prior exam and shows no change. There is no evidence of new bleed since prior exam. Ventricular size remains within normal and with no midline shift. No evidence of intraventricular hemorrhage. Follow-up with an MRI examination for further detailed evaluation of extent of injury is recommended. Calvarium is intact. Limited view of the orbits are unremarkable. Visualized paranasal sinuses demonstrate minimal soft tissue density within the right maxillary sinus. Mastoid air cells and middle ear cavities are pneumatized and unremarkable.
1.No evidence of new hemorrhage is prior study.2.Foci of edema in the right anterior temporal with minimal hemorrhage, edema in the right anterior frontal lobe with no hemorrhage or bleed can represent areas of contusion. A small amount of subarachnoid hemorrhage in right parietal region.3.CSF density subdural collections bilaterally as detailed. This finding is more pronounced on the left and the suggestion of interval increase since prior examination of the same date.4.Follow-up with an MRI is recommended.