FIG 1. Patient 1.

A, Skull radiograph 4 hours after injury shows a widely diastatic right frontal skull fracture.

B, CT scan of acute cranial burst fracture 4 hours after injury shows hemorrhagic contusion beneath the fracture, overlying scalp swelling, and moderate eversion of fracture edges.

C and D, Axial T2-weighted (3000/100/1) (C ) and sagittal T1-weighted (549/20) (D) MR images 15 hours after injury show acute transcalvarial brain herniation. Brain parenchyma is clearly differentiated from scalp soft tissue and hematoma. Note associated convexity and interhemispheric subdural hematoma and cortical contusions.