Neuro_CT_Head_Face_CSpine: 49 F, high speed MVA, through windshield.
CT HEAD, FACE, AND CERVICAL SPINE WITHOUT CONTRAST AND CT ANGIOGRAM
NECK WITH CONTRAST:
CLINICAL HISTORY: 49-year-old female, status post high-speed MVC. Went through the windshield.
FINDINGS:
BRAIN:
Parenchyma: No acute infarction or intraparenchymal hemorrhage.
Ventricles and extra-axial spaces: Appropriate for age. No
hydrocephalus.
Visualized paranasal sinuses: Clear.
Mastoid air cells: Clear.
Bones: No focal abnormality.
the soft tissues of the right frontoparietal scalp. No underlying
calvarial fracture.
INTRACRANIAL ANGIOGRAM:
Anterior circulation: No flow-limiting stenosis or aneurysm.
Posterior circulation: No flow-limiting stenosis or aneurysm. Normal
vertebral arteries.
Dural venous sinuses: Patent.
Additional comment: None.
EXTRACRANIAL ANGIOGRAM:
Proximal great vessels: No flow-limiting stenosis or dissection.
Cervical vessels:
Left distal cervical ICA is focally severely narrowed with small amount of flow seen within the segment. There is an associated perivascular hematoma. There is symmetric flow in the bilateral carotids distal to this with symmetric flow intracranially. Mild narrowing of the left carotid bifurcation.Additional comment: None.
NECK:
Soft tissues: Normal.
Bones: Normal.
Lung apices: Lung contusions in the bilateral lung apices.
Additional comment: None.
FACE:
Bones: No acute facial fracture.
Orbits: Normal.
Paranasal sinuses: Clear.
Mastoid air cells: Clear.
Soft tissues: Soft tissue abrasion and laceration of the left lower face and right lower lip.
CERVICAL SPINE:
Alignment: There is loss of the normal lordosis, which may be related to patient positioning or muscle spasm. There is widening of the distance between the posterior arches of C1 and C2, as well as widening of the distance between the basion and the tip of the dens, compatible with ligamentous injury.
Vertebrae: Vertebral bodies and posterior elements are intact without acute fracture. Multi-level degenerative changes in the mid cervicothoracic spine.
Extra-vertebral soft tissues: There is abnormally increased hyperdensity anterior to the ventral cord extending from the cervicomedullary junction to the level of C4.
Additional comment: None.
IMPRESSION:
1. Focal severe narrowing of the distal left cervical internal carotid artery with associated perivascular hematoma consistent with vascular injury. Small amount of flow seen at this segment with symmetric appearance of the intracranial vessels.
2. Increased hyperdensity anterior to the ventral cord extending from the cervicomedullary junction to the level of C4 concerning for acute epidural hematoma with some mass effect on the cervicomedullary junction.
3. Occipitoatlantal dissociation with widening of the basion to dens distance and space between the arches of C1 and C2.
4. Multiple soft tissue abrasions and lacerations with acute soft tissue hemorrhage in the right frontoparietal scalp.
5. Mild narrowing of the left carotid bifurcation. It is unclear if this finding is due to atherosclerotic disease or vascular injury.
6. Mediastinal hematoma and lung contusions in the bilateral lung apices better characterized on today's chest CT.
(Occipitoatlantal dissociation, epidural hematoma, traumatic vascular injury)
Normal basion-dens interval (BDI): <12 mm (plain film), <8.5 mm (CT)
Accession: CL27388572
Study description: CT HEAD CSPINE
