Case: 23-year-old Woman Involved in a Motor Vehicle Accident

by Roy Strowd, MD

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    00:01 So let's start with a case.

    00:02 This is a 23 year-old woman who's involved in a motor vehicle accident and presents to the emergency room for evaluation.

    00:09 She was the restrained passenger and a head on collision with the truck.

    00:13 Airbags deployed and she has bruising in the region over her seatbelt.

    00:18 She was noted to have lost consciousness at the scene and presents for evaluation where imaging shows scattered areas of hyperdensity consistent with multifocal punctate hemorrhages.

    00:30 So what's the most likely diagnosis? Is this epidural hematoma, subdural hematoma, subarachnoid hemorrhage or intraparenchymal hemorrhage? Well, this presentation is inconsistent with an epidural.

    00:41 The location of these hyperdensities is in the brain, not outside of the brain in the epidural space.

    00:46 This doesn't sound like the description of an epidural hematoma.

    00:50 It doesn't sound like subarachnoid hemorrhage.

    00:52 Again, the hyperdensities in our case are inside the brain.

    00:56 With subarachnoid hemorrhage, we suspect hemorrhage in the subarachnoid space and we're not hearing that in this case.

    01:02 This doesn't sound like a subdural hematoma, which presents as a crescent-shaped lesion on the surface of the brain.

    01:08 The hyperdensity in our patient is in the brain proper.

    01:12 So this is a typical presentation of a patient who's likely suffered traumatic intraparenchymal hemorrhage.

    01:18 The patient may have suffered also diffuse axonal injury, but it's clear that that hyperdensity inside the brain is suspicious for intraparenchymal traumatic hemorrhage.

    About the Lecture

    The lecture Case: 23-year-old Woman Involved in a Motor Vehicle Accident by Roy Strowd, MD is from the course Head Trauma.

    Included Quiz Questions

    1. Intraparenchymal hemorrhage
    2. Subdural hematoma
    3. Epidural hematoma
    4. Subarachnoid hemorrhage
    5. Intraventricular hemorrhage
    1. Diffuse axonal injury
    2. Hydrocephalus
    3. Basilar skull fracture
    4. Orbital rim fracture
    5. Intraventricular hemorrhage

    Author of lecture Case: 23-year-old Woman Involved in a Motor Vehicle Accident

     Roy Strowd, MD

    Roy Strowd, MD

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