 BRAIN: There is T1 hyperintense subdural fluid posterior to the cerebellum, along the tentorium, and along the falx cerebri posteriorly, as well as subpial T1 hyperintense fluid within multiple frontal and parietal sulci compatible with subacute hemorrhage. There is corresponding decreased diffusion in some of these regions which is likely artifactual secondary to the hemorrhage. There are however additional foci of decreased diffusion within cortices adjacent to a falcine subdural hemorrhage that likely represents compression ischemia. In addition, there are foci of decreased diffusion in the corpus collosum and right peri-atrial white matter that are compatible with traumatic axonal injury. Within the midline there is an approximately 19 x 12 mm focus of susceptibility effect and fluid fluid level compatible with intra-falcine hematoma. It essentially unchanged in size allowing for differences in technique. There is adjacent T2 hyperintensity compatible with vasogenic edema within the surrounding bilateral white matter. Along both frontal convexities there are T2 hyperintense subdural fluid collections that are new since the prior exam and measure up to 5 mm on the left and 3-mm on the right. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid within the bilateral mastoid air cells and developing paranasal sinuses.CERVICAL SPINE: There is thin T1 hyperintense T2 hypointense fluid measuring up to 1 mm within the subdural space anterior to the medulla and ventral to the spinal cord at the C1-C4 levels. In addition, there is T1 and T2 hyperintense fluid along the dorsal epidural space extending from the T1 level inferiorly to at least the T7 level and below the level of this exam. It also extends superiorly, wrapping around the cord up to the C6 level. There is no cord signal abnormality or spinal canal stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.
1.Essentially unchanged intracranial subdural and subpial hemorrhage as well as a large interhemispheric hematoma with adjacent edema.2.Foci of compression ischemia adjacent to the interhemispheric hematoma. 3.Small foci of diffusion restriction most compatible with traumatic axonal injury within the corpus callosum and right peri-atrial white matter. 4.New subdural post-traumatic effusions along the bilateral frontal convexities. 5.Epidural and subdural hematomas within the cervical and upper thoracic spinal canal, extending below the level of this exam. There is no cord signal abnormality, cord compression, or significant spinal canal stenosis. 