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.
The lecture Case: 23-year-old Woman Involved in a Motor Vehicle Accident by Roy Strowd, MD is from the course Head Trauma.
In a patient with a traumatic injury as well as imaging revealing multifocal punctate hemorrhages within the brain, what is the most likely diagnosis?
What other diagnosis should be considered in a patient presenting with punctate hemorrhages on brain CT after a head injury?
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