Traumatic Brain Injury, Skull Fractures, and Intracranial Herniation — WACS Viva & Clinical Scenarios (Neuroradiology and Head and Neck Imaging)

Exam-style traumatic brain injury, skull fractures, and intracranial herniation viva scenarios with examiner probes and model answers for Radiology candidates.

Scenarios covered

• SCENARIO 1: A 24-year-old male presents to the trauma emergency department following a high-speed motorcycle crash with a Glasgow Coma Scale (GCS) score of 7. You are provided with non-contrast axial cranial computed tomography (CT) images displaying an extra-axial hyperdense collection in the right temporoparietal region. Provide a structured radiological report detailing the morphological features of the collection, the presence of active extravasation, secondary mass effect, and an immediate actionable surgical recommendation.
• SCENARIO 2: A 32-year-old pedestrian struck by a motor vehicle is comatose on arrival. Emergency non-contrast cranial CT reveals petechial microhaemorrhages along the grey-white matter junction, the splenium of the corpus callosum, and the dorsolateral upper midbrain. Identify the definitive diagnosis, state the underlying grading scheme based on anatomical location, and justify which advanced magnetic resonance imaging (MRI) sequences offer the highest diagnostic sensitivity for this condition.
• SCENARIO 3: A 45-year-old female presents with severe traumatic head injury and bilateral fixed, dilated pupils. The non-contrast CT shows extensive left hemispheric swelling with effacement of the suprasellar and ambient cisterns, medial displacement of the uncus, and linear hyperdensities in the midbrain and upper pons. Describe the specific intracranial herniation patterns demonstrated, explain the vascular and neurological territories at risk, and identify the pathophysiological mechanism of the brainstem lesions.
• SCENARIO 4: A 19-year-old male involved in physical assault sustains blunt trauma to the right temporal region, presenting with cerebrospinal fluid (CSF) otorrhea, haemotympanum, and lower motor neuron facial nerve palsy. You are provided with high-resolution bone-algorithm CT images of the petrous temporal bone. Systematically classify the fracture pattern, assess the integrity of the otic capsule and carotid canal, and outline the key anatomical structures requiring evaluation.
• SCENARIO 5: A 60-year-old male with chronic alcohol use disorder presents with fluctuating altered sensorium two weeks after a minor fall. Non-contrast brain CT demonstrates a crescentic, crescent-shaped extra-axial collection along the left cerebral convexity with mixed hypodense and hyperdense layering. Characterize the chronological stage of the collection, explain the hematocrit effect, differentiate it from acute subdural and epidural collections, and identify potential imaging mimics.