Assessment #1 case-set #2 case #6 vanderbilt

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Subdural hematoma involving the left frontal and temporal lobes with midline shift. There may be an additional right parietal subdural. Succal effacement. No fracture noted.

Large left frontal epidural hematoma without associated fracture. Overlying small soft tissue hematoma. Sulcal effacement and midline shift to the right with partial effacement of left lateral ventricle.

Scattered SAH. Left anterior-frontal epidural hematoma with midline shift. Right SDH.

Large area of mostly isoattenuating, with some hyperattenuating density along the left frontotemporal region, likely an acute on chronic subdural hematoma. This causes sulcal effacement and mild midline shift. No hydrocephalus.

epidural hematoma with uncal herniation and bilateral soft tissue contusions

left front convexity epidural blood collection. there is left to right midline shift. basal cisterns are patent.

epidural w/herniation

Subdural hemorrhage overlying the bilateral frontoparietal lobes, left greater than right. There is mass effect resulting in rightward midline shift and entrapment of the left lateral ventricle. Recommend neurosurgery consultation.
No acute calvarial fracture of soft tissue injury.

subarachnoid or early subdural? hemorrhage along the left frontal convexity

left epidural hematoma with rightward shift

Left frontal mass with intraparenchymal hemorrhage causing significant mass effect, edema and compression of the lateral ventricle.

evidence of a moderate to large subarachnoid hemorrhage along the left frontal convexity with possible extension adjacent to the temporal lobe. findings consistent with mass effect, including sulcal effacement, left lateral ventricle effacement as well as small amount of midline shift. no herniation. no skull fracture

FINDINGS:

There is a large left subdural hematoma which is isoattenuating to the surrounding brain tissue, likely subacute in nature. There is surrounding edema causing diffuse sulcal effacement, left worse than right, with loss of gray-white differentiation. Mass effect on the ventricles with left to right midline shift and partial effacement of the left lateral ventricle. Associated subfalcine and uncal herniation.

The mastoid air cells are clear. Mucosal thickening of the paranasal sinuses.

The bones are unremarkable. No evidence of fracture or other trauma to the skull or soft tissues of the scalp or face.

IMPRESSION:

1. Subacute left frontal/parietal subdural hematoma with associated edema and mass effect causing left to right midline shift, partial effacement of the left lateral ventricle, and subfalcine and uncal herniation.
2. Diffuse sulcal effacement consistent with widespread cerebral edema.

Bilateral isodense subdurals

Left frontotemporal epidural hematoma with mixed density blood concerning for active extravasation. Mass effect with midline shift.

There are two separete hyperdense extra-axial collections, one surrounding the left frontal lobe and the other spreading over the right frontal and parietal lobes, both representative of subdural hemorrhage. There is mass effect causing midline shift from left to right as well as compression on the right lateral ventricle. There is also sulcal effacement. No definitive acute ischemia or herniation.

Mass effect with midline shift to the right secondary to intraparenchymal hemorrhage at the left frontal lobe

L SDH with ML shift

left frontal lobe-subdural and sah hemorrhage measuring x
subfalcine mass effect to right measuring x
diffuse global edema
effacement of sulci and ventricles

recommend mri w/ and w/o

Epidural hematoma along the left fronto-parietal convexity with associated mass effect effacing portions of the L lateral ventricle and causing midline shift. No acute underlying fracture of the calvarium. There is L to R subfalcine herniation. Sulcal effacement throughout out the cerebrum. Subdural hematoma along the falx.

Mixed density extra axial collection in the left frontotemporal convexity measuring x mm in maximum thickness, favored subdural hematoma. Higher intensity areas in the inferior aspect of this collection may reflect more acute hemmorhage, with adjacent edema noted.There is associated mass effect with left to right mid line shift with enlargement of the left occipital horn likely reflecting ventricular entrapment.

left frontal epidural hematoma.

bilateral extraaxial mixed isoattenuating and hyperattenuating collections along the left frontal and right high parietal cerebral convexities with associated mass effect (rightward, measuring x cm) and local mass effect and sulcal effacement. No underlying calvarial fracture noted. These findings are most concerning for bilateral SDHs. (coup, counter-coup). GW matter differentiation preserved.

scattered sulcal hyperattenuating foci may represent SAH.

No hydrocephalus. No ventricular entrapment.

scatter paranasal sinus thickening.

Left subdural measuring x in greatest thickness. X left to right midline shift. No hydro.
Right subdural measuring x in greatest thickness.

Multicompartmental hemorrhage including acute left convexity subdural hematoma with subarachnoid and left frontal hemorrhage. Diffuse sulcal effacement and midline shift

Bilateral mixed density extraaxial fluid collections along the right frontoparietal convexity and left frontal convexity. Scattered subarachnoid hemorrhage within left frontal sulci. Left to right midline shift measuring approximately X cm, w subfalcine hernation. Subjacent sulcal effacement. Left greater than right white matter hypodensity, likely vasogenic edema. Stroke disclaimer.

Epidural hematoma along the left frontal convexity with a maximum thickness of X mm. There is mass effect with local sulcal effacement and L=>R midline shift of X mm. There mild is asymmetric enlargement of the right temporal horn of the ventricular system, concerning for entrapment.

No overlying displaced calvarial fracture. No large vascular territory ischemia.

Left frontal epidural hematoma with overlying subcutaneous hematoma. Right subarachnoid hemorrhage and intraparenchymal hemorrhage, contrecoup injury. Rightward midline shift.

Submitted, but didn’t save my answer.

Mixed density subdural collections along the left greater than right convexities. The left collection measures _mm in greatest dimension, and the right measures _mm in greatest dimension. There is mass effect on the adjacent sulci as well as _mm midline shift and subfalcine herniation. There is moderate mass effect on the left lateral ventricle. No evidence of hydrocephalus at this time.

No large stroke. No calvarial fx. Scattered mucosal thickening of the paranasal sinuses and fluid filled ethmoid air cells.

Isodense extraaxial fluid collection favored subacute subdural hematoma layering along the left cerebral convexity measuring up to xx. Associated local sulcal effacement. There is a second extraaxial collection, favored subacute SDH layering along the right high parietal cerebral convexity measuring up to xx. There is left to right midline shift with subfalcine herniation. Dilation of the right lateral ventricle may relate to entrapment with develping hydrocephalous. No tonsillar or tentorial herniation. No acute fracture.

Left frontal lobe extra-axial collection/lesion with mass effect and rightward midline shift. Partial effacement of left lateral ventricle and suprasellar cistern. Mild enlargement of the right temporal horn concerning for entrapment / early hydrocephalus. No iscehmia.

Large xx cm/mm left frontoparietal mixed density subdural hematoma with predominately isodense components and intermixed high density blood products along the anterior frontal bone reflecting acute on subacute/chronic blood products. XX mm/cm right frontoparietal isodense extraaxial fluid collection consistent with subacute subdural hematoma. Associated diffuse sulcal effacement, x mm rightward midline shift with early associated subfalcine herniation. Partial effacement of the basal cisterns with early transtentorial herniation. Mild crowding of the cerebellar tonsils consistent with cerebellar tonsillar herniation. Partial effacement of the left lateral ventricle with rounding of the right temporal horn concerning for entrapment. Partial effacemet of the fourth ventricle.

Biconvex mixed isodense/hypodense collection along the left frontoparietal convexity suggesting acute epidural hematoma with active bleeding measuring a maximum diameter of x cm, with associated left to right midline shift measured at the third ventricle, left greater than right sulcal effacement. Minimal subfalcine herniation and impending uncal herniation. No evidence of hydrocephalus or tonsillar herniation.

Acute mixed density subdural hemorrhage along the left cerebral convexity with areas of hypodensity concerning for active extravasation. There is significant right ward midline shift with diffuse sulcal effacement and subfalcine herniation. Reccomend emergent neurosurical consultation.

No hydrocephalus.

Multicompartmental hemorrhage with a large left frontal mixed attenuation likely epidural hematoma with low density ortions likely representing hyperacute blood. There is additional adjacent SDH along the bilateral cerebral hemispheres and scatted SAH. There is xmm left to right midline shift and effacement of the left lateral ventricle. Asymmetric enlargement of the right temporal horn is concerning for entrapment and developing hydocephalus.
There is diffuse sulcal effacement with subfalcine, transtentorial and cerebellar tonsillar herniation with effacement of the basilar cisterns.

Typed report and not saved.

Bilateral left greater than right extra-axial collection crossing suture lines favoring subdurals that are heterogenous density, acute on subacute. They measure X
-right ward midline shift measuring X
-Left to right subfalcine herniation
-assymmetric enlargment of the right lateral ventricle and prominence of the temporal horn compared to the left, could be ventricular entrapment and/or developing hydrocephalus – attention on follow up
-no obvious fracture
-mild crowding of the crural cisterns.

Lefft frontalcranial epidural/subdural hematoma with left to right midline shift efffacement of left lateral ventrical and foreman of monroe and hydrocephalus of 3rd and 4th ventricals

Mixed density L frontoparietal convexity extraaxial hemorrhage with about ……. midline shift, L lat ventr effacement and R lat ventr entrapment. Possible subfalc herniation

Large predominantly isodense subdural hemorrhage overlying the left frontal convexity containing elements of intermixed internal hyperdensity along its inferior extent, favored subacute in chronicity. Corresponding mass effect results in diffuse sulcal effacement throughout the bilateral cerebral hemispheres as well as __ cm of rightward midline shift with subfalcine herniation. Query mild white matter hypoattenuation involving the left greater than right frontal lobes, which is indeterminate though may reflect developing vasogenic edema. MRI can further characterize as clinically appropriate.

A smaller isodense to minimally hyperattenuating extra-axial hemorrhagic collection is noted overlying the right frontoparietal convexity, as well as some hyperdense thickening of the interhemispheric falx, likely reflecting additional foci of subdural hemorrhage.

Partial effacement of the left lateral ventricle is noted with near complete effacement of the left temporal horn. While no definite rounding of the temporal horn of the right lateral ventricle is noted, developing ventricular entrapment cannot entirely be excluded given asymmetrically increased prominence of the right temporal horn. Basal cisterns and foramen magnum appear patent.

No traumatic osseous or soft tissue findings. Paranasal sinus mucosal thickening noted.

Diffuse cerebral edema with loss of cerebral sulci and crowding at the vertex, concerning for global hypoxic ischemic injury.

Mixed density intraparenchymal hemorrhage and subdural hematoma along the left frontal convexity with local mass effect on the left lateral ventricle, sulcal effacement, several mm of rightward midline shift with subfalcine herniation. No acute fracture. Consider CTA for further evaluation due to concern for ruptured aneurysm as underlying etiology. Grey-white differentiation is maintained. No evidence of hydrocephalus. No intraventricular hemorrhage.

Heterogeneously enhancing extra-axial hemorrhage, favored epidural, along the left frontal convexity measuring approximately ___ at it’s widest point. There is approximately ___ of midline shift with subfalcine herniation. No evidence of hydrocephalous. No evidence of large vascular territory infarct. No acute osseous abnormalities. No discernable soft tissue contusion in the region of hematoma, recommend correlation with history and physical exam.

Left frontal mass lesion with areas of acute hemorrhage concerning for hemorrhagic conversion of mets or avm. Recommend mri with and without.

Midline shift measuring x

acute subarachnoid hem along bifrontal lobes c/f aneurysm. rec cta.
diffuse cerebral edema resulting in x L to R midline shift. r
mass effect on r lat ventricles and witha enlarged L temporal horn concernign for entrapment and developing hydrocephalus
no acute large vascualr territory infarct.

Mass lesion measuring X mm centered superior to the left putamen. There is surrounding vasogenic edema which results in mass effect with partial effacement of the left lateral ventricle and X mm of left to right midline shift. No evidence of herniation, hemorrhage, or ventricular entrapment.

Mixed density lens shaped extraaxial hemorrhage along the left frontal cerebral convexity concerning for epidural hematoma. Isodense extraaxial fluid collection along the right cerebral convexity concerning for subacute subdural hematoma. No displaced fracture of the overlying skull identified. Diffuse sulcal effacement. Compression of the lateral ventricles with slight rounding of the right temporal horn concerning for early hydrocephalus. Midline shift measuring *** at the septum pellucidum. No herniation. No acute large territory infarct. Recommend urgent neurosurgical evaluation.

Acute multicompartmental hemorrhage with large volume subdural hematomas along the left anterolateral and right posterior cerebral convexities and trace subarachnoid hemorrhage along the left cerebral convexity with significant right-ward midline shift, transtentorial and cerebellar tonsillar herniation, and right lateral ventricular entrapment and rounding of the right temporal horn, concerning for acute obstructive hydrocephalus. Recommend emergent neurosurgical evaluation.

intracranial atherosclerosis.

Large bilateral isoattenuating subdural hematomas overlying the cerebral convexities with associated global sulcal effacement, rightward midline shift, and cerebellar tonsillar herniation.

Hyperattenuating components within subdurals suggest acute components of hemorrhage.

Prominence of the temporal horns raises concern for hydrocephalus and possible trapped ventricles.

Mixed attenuating lesion of the left frontotemporal lobe measuring with surround vasogenic edema. Mass effect from lesion and surrounding vasogenic edema result in effacement of the left greater than right sulci, left lateral ventricle, third ventricle, basal cistern. Left to right midline shift with no obvious herniation. No evidence of hydrocephalus.

3

Large mixed density left anterior frontal temporal subdural hematoma suggesting acute on chronic hemorrhage. Left to right midline shift, sulcal effacement and mass effect on the left frontal horn.

Acute left subdural hemorrhage resulting in midline shift and subfalcine herniation. Sulcal effacement and trapped left ventricle. No hydrocephalus. No ischemia.

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Acute left frontal epidural hemorrhage with rightward midline shift and subfalcine herniation.

Acute on subacute L frontal SDH with Rward midline shift, effacement of L ventricle, and subfalcine herniation.

Subacute high R frontoparietal SDH with mild local sulcal effacement.

No hydrocephalus.

extra-axial isoattenuating subdural collection along the left greater than right cerebral convexities favored to represent early subacute subdural hematoma. Crowding of the foramen magna with suprasellar cistern likely representing herniation. Balooning of the left temporal horn of the lateral ventricles. Rightward midline shift measuring xmm with effacement of the left lateral ventricle.

Mixed attenuation subdural collection over the left frontotemporal region, consistent with acute on chronic subdural hematoma. There is midline shift and mass effect.
Question additional isoattenuating collection of the right cerebral convexity.

Isodense collection along the left frontal/parietal convexity which exhibits local mass effect with x mm midline shift and partial left lateral ventricular effacement. The more inferior aspects of this collection contain higher density material, which could suggest acute on chronic subdural hematoma.

Subdural hematomas overlying the bilateral cerebral convexities measuring x cm. The left subdural has both hyperattenuating and isoattenuating components, concerning for acute on chronic hemorrhage. The left subdural is isoattenuating, favored chronic. There is diffuse sulcal effacement and x mm of left to right midline shift. There is asymmetric enlargement of the right lateral ventricle and rounding of the temporal horn concerning for ventricular entrapment and early hydrocephalus.
Scattered mucosal thickening of the paranasal sinuses.

Left front convexity isoattenuating extraaxial collection concerning for acute on chronic subdural hemorrhage. Midline.

Acute epidural hematoma with mixed attenuation concerning for active hemorrhage. There is associated mass effect with sulcal effacement with midline shift measuring xxx. Possible crowding of the fourth ventricle concerning for uncal/transtentorial herniation. No frank cerebellar tonsillar herniation.

bilateral subdurals. mass effect. no herniation or hydrocephalus.

R SDH and L EDH L > R with midline shift. slight nondisplaced fraccture of the temporal bone at level of sphenoid wing

mid line shift

Diffuse low attentuation in the left hemisphere with left to right midline shift and effacement of the left lateral ventricle.

Left frontoparietotemporal mixed density subdural hemorrhage measuirng up to 15mm in thickness. Adjacent mass effect with left cerebral sulcal effacement, 5mm of midline shift and left to right subfalcine herniation. Mass effect on the left lateral ventricle with ballooning of the right temporal horn, concerning for developing hydrocephalus.
Basal cisterns are patent. No acute fracture. Mucosal thickening of the ethmoid air cells.

subacute epidural hematoma along the left frontal convexity with associated sulcal effacement, rightward midline shift, uncal herniation into the left lateral ventricle. There is no hydrocephalus.

Bilateral acute/subacute subdural hematomas resulting in sulcal effacement, rightward midline shift, partial effacement of the left lateral ventricle, and mild subfalcine herniation (although herniation could be far more adequately assessed with coronals lol).

large epidural hematoma of the left frontotemporal region.
mass effect with __cm of left to right midline shift.
no acute fracture.
mild ethmoid sinus disease.

Large isodense convex collection about the left cerebrum concerning for an epidural hematoma resulting in sulcal effacement, partial effacement of the lateral/third ventricles, and rightward shift.

epidural

Lentiform extraxial hyperattenuation along the left cerebral convexity concerning for Acute epidural hematoma with x mm of left to right midline shift.
There is diffuse vasogenic edema.
Asymmetric enlargement of the right lateral ventricle concerning for early hydrocephalus.

Large subdural collections over bilateral frontoparietal convexities measuring x mm in maximal thickness. Internal foci of more attenuating blood products consistent with acute on chronic hemorrhage. Mass effect including diffuse sulcal effacement, effacement of the left lateral ventricel and supracellar cistern, and rightward midline shift measuring x mm.

mixed attenuation extraaxial collection along the left cerebral convexity measuring xx in maximal diameter. Hyperattenuating components may represent acute/subacute hemorrhage.

There is local sulcal effacement and xx mm midline shift with subfalcine herniation. Partial effacement of the LL ventricle. No hydroceph

Epidural along the left cerebral convexity with regions of hyper and hypoattenuation concerning for hyperacute blood products. There is significant sulcal effacement with left to right midline shift. There is rounding of the left laterla venticle concerning for delvoeping hydrocephalus and ventricular entrapment.

Isoattenuating extra-axial collection adjacent to the left cerebral convexity with associated mass effect resulting in local sulcal effacement, X mm of right to left midline shift and partial effacement of the left lateral ventricle. Findings are favored to represent a chronic subdural hematoma that measures x thickness in maximum diameter.

No evidence of acute large vascular territory infarct.

Multifocal areas of intraparenchymal hemorrhage along the L frontal lobe and R basal ganglia with left to right midline shift.

-No acute large vascular territory infarct.
-Predominantly isodense left extra-axial collection with intermixed hyperattenuation measuring x cm, suggestive of acute on subacute epidural hematoma. Adjacent mass effect, sulcal effacement and left to right midline shift.
-There is asymmetric effacement of the left lateral ventricle and mild rounding of the temporal horn of the right ventricle, suggestive of entrapment/early developing hydrocephalus.
-Predominantly isodense right extra-axial collection overlying the right cerebral convexity, suggestive of subacute subdural hematoma.

There is left frontal subdural and subarachnoid hemorrhage in a background of hypoattenuation blood. There is left frontal parenchymal edema. There is corresponding left to right midline shift with effacement of the lateral ventricles. There is a left parietal soft tissue contusion and underlying nondisplaced fracture.

Biconvex epidural collection along the left frontal convexity that is large isoattenuating with components of hyperattenuation, concerning for actively bleeding epidural hemorrhage.

mass with hem?

Large subdural hematoma alond the L anterior frontal lobe convexity with R ward mass effect. There appear to be mixed attenuation within the collection concerning for active extrave
There is Subfalcine herniation.

sah in the bilateral frontal lobes, diffuse vasogenic edema with sulcal effacement, left to right midline shift subfalcine herniation, no uncal or cerebellar tonsillar herniation, entrapment of the right ventricle

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Subacute epidural hematoma along the anterior left frontal convexity with surrounding edema and left to right shift with no definite herniation.