Assessment #1 case-set #4 case #13 vanderbilt

Left epidural and subdural hematomas

Acute and subacute epidural hemorrhages with mass effect and left subfalcine herniation

Bilateral subdural hematoma with larger epidural hematoma causing significant mass effect and rightward midline shift, obstructive hydrocephalus with completely effaced left lateral ventricle, distended right lateral and third ventricles. Possible small subarachnoid hemorrhage in right frontal lobe. Transtentorial and subfalcine herniation. No fractures. Emergent neurosurgery consultation is recommended.

LARGE MIXED DENSITY SUBDURAL HEMORRAHGE ALONG THE ENTRIE L CEREBRAL CONVEXITY WITH Resultant RIGHTWARD MIDLINE SHIFT and effacement of the L lateral ventricle and sulcal effacement.
Additional remote subdural hemorrhage layering along the R falx.

No hydro or herniation.

FINDINGS:

Acute and subacute subdural hematoma along the left temporal/parietal lobes. Additional small acute epidural hematoma along the right frontal lobe. Evidence of mass effect with left-to-right midline shift and partial effacement of the left lateral ventricle with entrapment. No osseous abnormality seen. Opacification of the right mastoid air cells.

IMPRESSION:

Subdural and epidural hematomas as described above.

Large acute on chronic subdural hematoma layering along the L cerebral convexity with left to right midline shift.
Small chronic R frontal extra axial collection.

multiple regions of subdural hematoma, the largest extending along the left lateral convexity anterior to posterior adjacent to the frontal, parietal, and temporal lobes. this region contains both anterior hypodense and posterior hyperdense components, representing chronic and acute hemorrhage, respectively. additional chronic appearing subdural hematoma is present along the superior frontal convexity and layers along the falx. an acute component is present near the posterior falx as well as the right occipital convexity. small amount of acute subdural hemorrhage layering along the left tentorium. there is evidence of mass effect with right cerebral sulcal effacement and right lateral ventricle effacement. several mm of left to right midline shift is present. no evidence of herniation or hydrocephalus.

Acute on chronic subdural hematoma, left cerebral convexity. Reward midline shift. Ventricular entrapment.
Subarachnoid hemorrhage overlying the right frontal lobe.

large L SDH

Bilateral extra axial fluid collections, left greater than right. There is left to right midline shift with entrapment of the right lateral ventricle.

biconvexity acute on chronic subdurals measuring x cm with mass effect on adjacent sulci and left to right midline shift measuring x mm, uncal herniation, subfalcine herniation, ventricular entrapment (right).
Bilateral mastoid effusions.

Large SDH with subfalcine herniation

large sssubdural left sided – mass effect cauising midline shift

There is left frontoparietal convexity that is partially hypodense and partially hyperdense. This is likely a subdural hemorrhage causing moderate mass effect with sulcal and ventricular effacement along with left to right shift and subfalcine herniation. No visible infarct. No hydrocephalus.

epidural and subdural collections with significant mass effect and uncal herniation

Large subdural hematoma along the L cerebral convexity measuring x mm with differing densities suggesting an acute on chronic age of the subdural. Additional subdural hemorrhage along the falx and L greater than R tentorial leaflets. Mass effect with sulcal effacement and x mm of midline shift and compression of the L lateral ventricle. Associated subfalcine herniation is present. No acute hemorrhage.

Mixed attenuation extra-axial hemorrhage concerning for acute on chronic subdural hematoma, with more acute findings (measuring xx) along the left posterior cerebral convexity and more chronic findings along the more anterior cerebral convexity, extending inferiorly to the inferior frontal and temporal lobes. there is approximately x mm of left to right midline shift.

Large left sided extra axial collection, with layering hyperattenuating compoennts, consistent with Subdural hematoma. Thickening of the tentorial leaflets, left greater than right, as well as a small right sided SDH along the high parietal convexity and right sided interhemispheric falx..

Significant mass effect with subfalcine herniation and expansion of the right lateral ventricle, likely representing ventricular entrapment.

Large acute on chronic L frontal SDH with associated rightward midline shift and subfalcine herniation as well as effacement of local sulci and left lateral ventricle. Additional, smaller layering of SDH along the falx and high R cerebral convexity. SDH are favored acute on chronic given layering of dependent layering of high attenuating blood products.

Mixed acute/subacute subdural hematoma along the left cerebral convexity, right anterior cerebral convexity and interhemispheric fissure. More acute components within the posterior aspect of the convexity. Associated left greater than right sulal effacement with mass effect and x left to right midline shift measured at the third ventricle, additional uncal and subfalcine herniation. No downward transtentorial herniation. Areas of collapsed left lateral ventricle and enlarged right lateral ventricle concerning for obstructive hydrocephalus. Additional likely small volume hemorrhage along the posterior falx and left tentorial leaflet. No visible associated calvarial fracture. No visible soft tissue contusion.

Complete opacification of the right mastoid air cells, partial on the left. Well-septated air cells. Correlate with signs of otomastoiditis.

Large left acute on chronic subdural hematoma with mass effect and resultant subfalcine and uncal herniation. Neurosurgery consult recommended.
Smaller acute on chronic subdural hematoma on the right.
No fracture or soft tissue injury.

Large left subdural bleed with associated mass effect, ventricular effacement and hernatiation.

large left subdural, midline shift, right lateral ventricular entrapment, left mastoid effusion

Mixed density acute on chronic subdural hemorrhage involving the left cerebral convexity measuring up to xx mm in max dimension. High density material layering posteriorly, concerning for active hemorrhage. Sulcal effacement with partial effacement of the left lateral ventricle and xx mm of midline shift and subfalcine herniation. Rounding of the right temporal horn, concerning for ventricular entrapment. Hemorrhage extends along the falx and R>L tent, measuring up to xx mm. Question small volume SAH seen in the subarachnoid space surrounding the upper spinal cord.

Large left cerebral convexity extra-axial collection with an isodense and hypodense component. Mass effect and rightward midline shift. Asymmetric enlargement of the right lateral ventricle concerning for developing hydrocephalus.

f

multicompart hem w mass effect, midline shift, herniation, ventricular entrapment

Large bilateral sdh of different ages, herniation and hydrocephalus

low density collection bilat frontal convexity, high density posterior left convexity and right convexity, measuring x, subdurals. mass effect and subfalcine herniation. effcaement of ventricle
subdural along falx and left tentorium.
hydrocephalus, lateral ventricles
opacification mastoids->otomastoditis

Large acute on chronic left lateral convexity subdural hematoma with midline shift. Early right ventricular entrapment.

Left convexity mixed density extraaxial fluid collection. Mass effect with effacement of sdjacent sulci, subfacline herniation, and X mm midline shift.

Acute on chronic subdural hematoma with layering blood products along the left cerebral convexity, which are hypoattenuating anteriorly and hyperattenuating posteriorly. Acute SDH along the right falx. There is X mm midline shift with left ventricular effacement.

large left subdural blood collection and small to moderate left subdural hemorrhage. Blood product is seen along the parafalcine region as well. There is significant left to right midline shift, the right lateral ventricle is asymmetrically enlarged. There is evidence of uncal and cerebebellar tonsils herniation.

Large acute on chronic left subdural hematoma. Rightward midline shift with herniation. Smaller right subdural. Sucal and vernticular effacement in the left.

Big subd measuring x, falx and convexity
Midline shift and effacement
Subfalc and uncal herniation
Right mastoid effusion
Ventricular entrapment,

Large mixed-density subdural hematoma spanning the left cerebral convexity with layering hyperattenuating component, likely an acute on chronic subdural hemorrhage, without underlying calvarial fracture.

Small left frontal convexity subdural hemorrhage, subacute to chronic-appearing.

Severe left to right midline shift resulting in subfalcine, uncal, and downward transtentorial herniation. No cerebellar herniation.

Enlarged right lateral ventricle with mass effect compressing the left lateral ventricle. Slit-like third ventricle with sulcal effacement, concerning for developing hydrocephalus. Recommend emergent neurosurgical consultation.

Chronic microvascular ischemic disease with intracranial atherosclerosis. No acute large vascular territory infarct; however, if this is of clinical concern, MRI is more sensitive.

bilat subdural, active extrav

acute EA, SD collection along the left cerebral convexity with mixed attenuation resulting in x mm rightward midline shift. + Hydro with entrapment of the left lateral occiptal horn

Layering mixed density subdural collection along the left cerebral convexity measuring approx _ mm in greatest dimension in coronal plane, consistent with acute on chronic subdural hematoma. There is considerable mass effect with left to right midline shift measuring approx _mm. Compression of the left lateral ventricle and third ventricle, with possible resulting ventricular entrapment of the right lateral ventricle, which appears enlarged. There is left to right subfalcine herniation and downward transtentorial herniation.
Low density subdural collection along the high right cerebral convexity and layering on the falx cerebri measuring _mm in greatest dimension, consistent with subacute/chronic subdural hematoma.

Large amount of extraaxial layering blood along the left frontal, parietal and temporal lobe with significant mass effect, sulcal effacement and uncal herniation causing effacement of the left lateral ventricle and left supersella cistern, as well as significant rightward midline shift. In addition, there is a small amount of hypodense blood product along the anterior frontal lobe and along the anterior falx. These findings are consistent with subacute subdural hemorrhage of the left frontoparietotemporal lobe with uncal and subfalcine herniation and effacement of left lateral ventricle, as well as right frontal lobe and anterior falx subdural hematoma.

There is a non displaced calvarial fracture of the left frontoparietallobe.

L subdural hematoma
subfalcine and transtentorial herniation
hydrocephalus and entrapment of the right lateral ventricle

large SDH, herniation

Large mixed density left subdural hemorrhage which spans the entire left cerebral convexity. Diffuse sulcal effacement, left greater than right. Associated mass effect with measurement. Left subfalcine and uncal herniation. Blood layers along the interhemispheric falx and tentorial leaflets.

Small right subdural hemorrhage.

Subarachnoid hemorrhage layering along the right frontal lobe and right cerebellopontine angle.

Ballooning of the right ventricle in the frontal and occipital horns with concern for acute hydrocephalus and ventricular entrapment.

Mixed density L greater than R cerebral convexity subdural hemorrhage.

Large mixed density subdural collection along the left cerebral convexity measuring *** in maximum thickness. Resultant mass effect with near complete effacement of the left lateral ventricle, rounding of the right lateral ventricle, midline shift measuring *** at the septum pellucidum, and subfalcine and uncal herniation.
Thin hypodense subdural collection along the high right frontal/parietal convexity.
SAH along the falx cerebri and left tentorium.
No large territory infarct.

left cerebral convexity extraaxial fluid collection measuring xx in maximal diameter. Hematocrit level with region of layering hypoattenuation concerning for acute hemorrhage. Effacement of underlying sulci. XX mm rightward midline shift with subfalcine herniation. Partial effacement of the left lateral vent with dilatation of the right lateral vent, concerning for entrapment.

Additional subdural tracking along the posterior falx and bilateral cerebellar leaflets L > R, measuring xx.

Right extraaxial fluid collection along the right cerebral convexity and vertex, extending along the right parafalx. areas of hypoattenuation within this collection may represent hyperacute blood products.

No large vasc territory infarct.

Left subdural

Acute multicompartment intracranial hemorrhage with the following components:
Acute left greater than right extra-axial collections consistent with acute subdural hematomas with internal hypoattenuation concerning for hyperacute blood products. There is diffuse sulcal effacement, left to right midline shift and medialization of the left uncus concerning for uncal herniation. Additional collections of extra-axial hemorrhage layering along the interhemispheric falx and bilateral tentorium cerebelli.

Additional scattered foci of subarachnoid hemorrhage layering along the right cerebral sulci and within the basal cisterns.

Global enlargement of the ventricular system concerning with rounding of the temporal horn of the right lateral ventricle concerning for obstructive hydrocephalus with ventricular entrapment.

L frontal subdural with midline shift, hydrocephalus

Mixed attenuation (acute on chronic subdural hematoma) collection along the left cerebral hemisphere.
Right hypoattenuating subdural collection over the left frontal convexity, measuring x in maximum thickness. Right isoattenuating to brain collection along the right posterior convexity, likely subacute hematoma.

Associated mass effect, x rightward midline shift, sulcal effacement, left uncal and subfalcine herniation, and effacement of the left ventricle with enlargement of the right lateral ventricle, including the temporal horn, atrium, and occipital horn, concerning for development of hydrocephalus.

Mixed density acute on chronic subdural hematoma along the right frontal convexity and right eccentric falx measuring up to x in thickness.

Mixed density subdural hemorrhage along the left cerebral convexity concerning for acute on chronic hemorrhage. This hemorrhage measures approximately ___ in greatest width. Mixed density hematoma along the Right side of the falx measuring ___ in greatest width. Layering subdural hemorrhage olong the Right tentorial leaflet.
Left convexity SDH results in sulcal effacement, Lateral ventricular effacement, and approximately ___ of midline shift. There is rounding of the right temporal horn of the lateral ventricle, concerning for developing hydrocephalous. Possible ventricular entrapment of the left lateral ventricle.
There is left to right subfalcine and possibly developing transtentorial herniation.

L greater than R acute on chronic subdural hematomas overlying the cerebral convexities, falx, and left tentorial leaflet.

mass effect results sulcal effacment, partial basal cistern effacement, in x midline shift, and downward transten herniation.

enlargement of the right temporal horn raises concern for entrapment.

large acute on chronic predominately left sided subdural hematoma with extra axial hemorrhage layering to a lesser degree along the posterior right hemisphere, the falx, and bilateral tentorial leaflets. there is xmm midline shift. effeacement of left lat ventricle and rounding of the the right themporal horn concerning for ventricular entrapment and hydrocephalus. periventricular hypoattenuatiuons concerning for transependymal flow of csf.
transtentorial and subfalcine herniation.

-Acute on chronic left subdural hematoma (hematocrit level) measuring X with X midline shift
-Chronic components along flax and right cerebral convexity
-Left to right subfalcine and uncle herniations
-Rounding of right temporal horn concerning for developing hydrocephalus
-Effacement of left lateral ventricle concerning for developing entrapment
-no calvarial fracture
-NSG consult rec

Hyperdens extraaxial fluid collection representing and acute subdural hematoma layering along the left cerebral convexity which measures up to xx. THere is extension along the posterior falx and left tentorial leaflet. Areas of hypodensity along the anterior left cerbral convexity, anterior falx, and to a smaller extend the right fronatal convexity raise concern for chronic subdural hematoma, versus regions of active bleeding.

There is left hemisphere sulcal effacement, left ot right midline shift measuring xx as well as subfalcine and left uncal herniation.

Effacement of the left lateral ventricle. Assymetric enlargement of the right lateral ventricle rasies cocnern for ventricular entrapment with developing hydrocephalous.

Large mixed attenuation extracollection over the left cerebral convexity. There is mass effect, midline shift, etc. Findings concerning for hydrocephalus with rounding of the temporal horns. Recommend emergent neurosurgical evaluation.

Bilateral left greater than right mixed attenuation subdural hemorrhages overlying the bilateral cerebral convexities measuring x cm. Hyperattenuating and hypoattenuating components with fluid- fluid levels are concerning for hyperacute blood products. This results in local sulcal effacement, x cm of rightward midline shift, and medialization of the medial left temporal lobe concerning for early uncal herniation.
Effacement of the left lateral ventricle and enlargmenet of the right lateral ventricle with rounding of the temporal and occipital horns concerning for entrapment and obstructive hydrocephalus.
Thin acute subdural hematoma along the falx and bilateral tentorial leaflets.
Nonspecific bilateral R>L mastoid effusions.

Large subdural hematoma over the left cerebral convexity with layering hyperattenuating material concerning for acute hemorrhage / hematohygroma measuring ***. There is associated midline shift measuring ***, sulcal effacement, subfalcine herniation and crowding of the fourth concerning for uncal herniation. There is enlargement of the right lateral ventricle concerning for entrapment.

Low attenuation subdural collecion over the right frontal convexity and along the anterior superior falx, also with layering hyperattenuating material concerning for hermorrhage/hematohygraoma.

Large acute on chronic subdural hematoma layering along the left cerebral convexity measuring up to x mm. x mm of left to right midline shift with subfalcine and uncal herniation. Enlargement of the right lateral ventrical with adjacent hypodensity concerning for ventricular entrapment and transependymal flow.
Acute on chronic right subdural measuring x mm in greatest thickness.
Additional subdural blood products layering along the falx and tentorial leaflets.

Mixed density left extra-axial collection measuring x mm in greatest width with the hyperdense components seen inferior to the hypodense component, suggestive of acute on chronic subdural hematoma. Adjacent mass effect, sulcal effacement, and rightward midline shift.
Effacement of left lateral ventricle with enlargement of the r lat ventricle, concerning for entrapment/hydrocephalus.
Developing uncal herniation
Another mixed denisty right subudural collection in the right high frontoparietal convexity.
No acute large vascular territory infarct.

Large L SDH w/ mass effect

Mixed density large x mm left subdural hematoma with hyperdensity layering in the occipital lobe and large hypodense component anteriorly which tracks along the left greater than right falx. This may represent acute on chronic hematoma or hyperacute active hemorrhage. Small right posterior cerebral convexity SDH which tracks along the falx. Associated sulcal effacement, x mm rightward midline shift, subfalcine herniation and impending left uncal herniation with mild mass effect on the left cerebral peduncle. Effacement of the left lateral ventricle with entrapment of the right lateral ventricle and rounding of the fourth ventricle concerning for early hydrocephalus. Cerebral atrophy and chronic ischemic white matter disease.