2. SALIENT FEATURES
• N.M.M
• 22/M
• Mild TBI GCS 15 with LOC
• NOI – MVA (2-wheel vs 2-wheel)
• TOI – 8PM
• DOI - 3/24/2023
• POI – Don Marcelino
3. CT cranial plain
• Done on 3/25/2023 at SPMC
• Indication: Rule out fracture, intracranial bleed
4. Multiplanar view
Coronal view Sagittal view Axial view
*Linear fracture with depressed component is seen in the left parietal bone with extension to the sagittal suture. There is widening of the sagittal, left coronal and
lambdoid sutures. Small lentiform hyperdense fluid collections are noted in the bilateral parasagittal convexities crossing the midline with a maximal thickness of 0.7
cm in the right and 0.8 cm in the left
5. IMPRESSION:
> LINEAR DEPRESSED FRACTURE, LEFT PARIETAL BONE, WITH
DIASTATIC FRACTURES, SAGITTAL, LEFT CORONAL AND
LAMBDOID SUTURES
> ACUTE HEMORRHAGIC CONTUSIONS (CONTRE-COUP
INJURIES), BILATERAL FRONTAL LOBES and LEFT PARIETAL
LOBE (COUP INJURY)
> VERTEX EPIDURAL HEMATOMA, AS DESCRIBED.
> TRAUMATIC SUBARACHNOID HEMORRHAGE, FALX CEREBRI
AND BILATERAL TENTORIUM CEREBELLI
> SUBGALEAL HEMATOMA, BILATERAL PARIETO-OCCIPITAL
REGIONS
6. Reference Image (Venogram)
Patient’s image (NECT)
Note: On the reference image, Venogram scan shows a vertex venous EDH crossing the midline.
The curved arrow show thrombosed SSS, and the straight cortical veins are displaced inferiorly.
7. • Usually caused by a linear or diastatic fracture
that crosses the superior sagittal sinus (SSS),
they often accumulate over hours or even days
with slow, subtle onset of symptoms
• Most common symptom: Severe
headache, pathogenesis
• Direct: Dural irritation around the SSS, which
SSS, which is rich in pain sensitive fibers
• Indirect: Raised intracranial pressure (ICP)
pressure (ICP) due to
obstruction/thrombosis of SSS
Patient’s image
Vertex Epidural Hematoma
(A Venous Epidural Hematoma)
8. Epidural vs Subdural Hematoma
Note: How the EDH is located above the outer dural
(green) and the SDH is located beneath the inner
dural (orange) layer.
9. Epidural vs Subdural Hematoma
Because epidural hematomas exist in the potential space between the
dura and inner table of the skull, they usually will not cross cranial
sutures, where the periosteal layer of the dura is firmly attached.
However, near the vertex, the periosteum forms the outer wall of the
sagittal sinus and is less tightly adherent to the sagittal suture.
Therefore, vertex epidurals, which are usually of venous origin from
disruption of the sagittal sinus, can cross midline
10. REFERENCES
• Osborn A.G. 2018. Osborn's brain: Imaging, pathology, and anatomy.
Primary Effects of CNS Trauma. 2nd ed. Philadelphia, PA: Lippincott
Williams & Wilkins; pp 23-24.
• Brant, W. E., & Helms, C. A. 2012. Fundamentals of diagnostic
radiology. Primary Head Injury: Extra-axial. pp. 165-166. Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins.
• Ramesh VG, Kodeeswaran M, Deiveegan K, Sundar V, Sriram K. Vertex
epidural hematoma: An analysis of a large series. Asian J Neurosurg.
2017 Apr-Jun;12(2):167-171. doi: 10.4103/1793-5482.145555. PMID:
28484524; PMCID: PMC5409360.
