29 yo M presenting after being involved in roll-over MVA.
1. Severe diffuse cerebral edema with midline shift, downward transtentorial and uncal herniation.
2. Multifocal intracranial hemorrhages in the bilateral hemispheres.
3. Comminuted calvarial fracture, including coronal suture diastasis, depression of left temporal and parietal bone, and transverse fracture of the left mastoid portion of the temporal bone. Fracture extends into the bilateral occipital condyles in expected regions of bilateral vertebral arteries' course.
4. Extensive facial fractures including the left zygomaticomaxillary complex, anterior/posterior/medial walls of left maxillary sinus, and left superior orbital wall. Additional fracture involving the left nasal bone, left maxillary process extending to the medial canthus and into the left nasolacrimal canal, the fovea ethmoidalis, and left olfactory groove.
5. Extraconal hematoma and gas in the left orbit.
(Severe acute TBI with herniation, fatal)