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

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.