Clinical question: Traumatic brain injury. Signs and symptoms: Increased tone. None CT of brain:Examination demonstrates significant ventriculomegaly of the lateral and third ventricle. There is a ventricular catheter entering from right posterior frontal, traversing the right parietal lobe and enters into the right lateral ventricle. The tip of the catheter traverses the midline and is at the level of the left foramina of Monro. There are no old films available for comparison of the ventricular size. There is a shallow CSF dense CT extra axial collection surrounding the bilateral cerebral hemispheres and is consistent with chronic subdurals. On the right side the thickest portion of the subdural measures 7.5-mm (axial image 17) and on the left subdural measures approximately 6.5 mm on axial image 15 in the frontal region). There is no areas of acute blood product within the subdural space.There is no evidence of parenchymal hemorrhage.No attenuation of brain parenchyma in the left temporal lobe extends from left anterior temporal posteriorly to involve the entire length of the left temporal lobe. This is believed to represent an area of old encephalomalacia. Possibility of an ischemic stroke cannot be however entire without. Please review outside studies or follow-up with an MRI exam. The cortical sulci are still preserved and are prominent and overall appearance of brain is suggestive of diffuse right lung volume loss.
1.No detectable acute posttraumatic findings.2.Low density extra-axial subdural collection encircles the entire brain parenchyma bilaterally as detailed.3.Significant ventriculomegaly and supratentorial space with a shunt in place. There are no old studies for comparison.4.Large area of low-attenuation involves the left temporal lobe which may represent encephalomalacia however less likely possibility of an ischemic stroke of more recent onset cannot be entirely ruled out.5.There is no evidence of skull fracture.6.Extensive exaggerated pneumatization of visualized paranasal sinuses.