Figure 2.

Head CT and MRI scans of a 12-year-old girl who was struck by an automobile while crossing the street and was immediately rendered unconscious, with a fixed and dilated right pupil.

1. This CT scan was obtained within 2 hours of the injury: at this time, both pupils were fixed and dilated. There is a right frontotemporal subdural hematoma of the same width as the calvaria, as well as a small right temporal hemorrhagic contusion and very marked right-to-left shift of the midline structures, mainly due to swelling of the right hemisphere. These findings would be classified as grade IV in the scheme of Marshall et al. 1991 (e4). A short time after this image was taken, an extensive right hemicraniectomy was performed, along with removal of the acute subdural hematoma.

2. and c) MRI on day 2 shows a large right temporal contusion, but no brainstem injury.