Cerebral Edema, Subdural Hematoma, Absent supratentorial flow on CTA

Findings:

Axial CTA source images demonstrate absence of supratentorial vascular enhancement. The basilar artery enhances, but there is no enhancement of the posterior cerebral arteries. Diffuse loss of grey white differentiation is present, with marked effecement of the suprasellar cistern, third ventricle, and sulci. Subdural hemorrhage extends along the convexities, falx, tentorium, and upper spinal canal. Sphenoid sinus fluid is present. Scalp soft tissue swelling is incompletely included with calvarial fractures.

Discussion

Absent vascular enhancement may be seen with an injection error, but the presence of vessel enhancement infratentorially indicates a lack of supratentorial flow. Multiple vessel thrombosis would be unlikely, and the presence of significant intracranial mass effect should raise concern for intracranial pressure exceeding mean arterial pressure.

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