Image Based Question-71066

A young child sustained a head injury and later complained of headache and drowsiness. On
admission,the child was unconscious.

The vital signs were stable and a skull X-ray did not demonstrate a fracture.An urgent CT brain was performed.What is the likely diagnosis?

A. Cerebral Infarct.

B. Extradural Hematoma.

C. Subarachnoid Hemorrhage.

D. Subdural Hematoma.

Show Answer

Correct Answer » B Explanation

Ans:B. Extradural Hematoma.

Image shows:

Non-contrast axial CT of the brain showing an acute right frontoparietal extradural haematoma(arrows) with mass effect on the underlying brain and lateral ventricles, midline shift to the left.

The low density areas (arrowheads) within the extradural indicate active bleeding.

Extradural Hematoma

• Bleeding sources of extradural haematoma:

• Arterial (90%): tear of the middle meningeal or other meningeal arteries

• Venous (10%): sinus laceration, tear of meningeal vein

• CT features of EDH:

1. Biconvex/lenticular in shape
2. The haematoma does not cross the coronal and lambdoid sutures
3. May cross dural reflections falx cerebri and tentorium cerebelli
4. Most are associated with skull vault fractures .
5. Low density areas within the EDH indicate active bleeding and thus heterogeneity may predict rapid expansion of the haematoma .
6. Venous EDHs from low pressure bleed are more variable in shape and may have delayed onset.