Is the non‑contrast head computed tomography normal in a patient who fell and struck their head, with age‑appropriate brain volume, no midline shift, no extra‑axial fluid collection, no acute intracranial hemorrhage, and normal posterior fossa, fourth ventricle, mastoid air cells, and paranasal sinuses?

Yes, This CT is Normal

Based on the radiology report provided, this non-contrast head CT is completely normal and shows no acute traumatic injury. 1, 2, 3

What the Report Tells Us

The CT demonstrates:

• No acute intracranial hemorrhage (no bleeding inside the skull) 1, 2
• No extra-axial fluid collection (no blood or fluid between the brain and skull) 1
• No midline shift (brain structures are in their normal position, indicating no mass effect) 1, 4
• Normal posterior fossa structures (cerebellum and brainstem are normal) 1
• Age-appropriate brain volume (no unexpected atrophy or swelling) 1
• Clear mastoid air cells and paranasal sinuses (no associated skull base or sinus abnormalities) 1

Clinical Significance After Head Trauma

This normal CT result is highly reassuring in the acute trauma setting. Non-contrast head CT is the gold standard for detecting neurosurgical emergencies including hemorrhage, herniation, and hydrocephalus, with high sensitivity for acute bleeding. 4 The American College of Radiology recommends non-contrast head CT as the definitive initial imaging modality for acute head trauma because it rapidly detects these critical findings. 4

A normal CT in a patient with mild traumatic brain injury (GCS 14-15) who is neurologically intact indicates very low risk for deterioration. 1 Studies show that patients without risk factors who have normal CT findings do not deteriorate even when discharged. 1

What This Means for Patient Management

If the patient has a normal neurological examination and this normal CT, they can typically be safely discharged from the emergency department with appropriate return precautions. 1 The primary outcome measure in mild TBI guidelines is the presence of acute intracranial injury on CT—which is absent here. 1

Important Caveats:

• If the patient is on anticoagulation, closer observation may be warranted even with a normal initial CT, as delayed hemorrhage can occur. 3
• If symptoms worsen or new neurological deficits develop, repeat imaging would be indicated. 2, 4
• For persistent post-concussive symptoms beyond 7 days, MRI may be more sensitive than repeat CT for detecting subtle white matter injury or microbleeds not visible on the initial CT. 2, 4

The negative predictive value of a normal non-contrast head CT with the same clinical indication is very high—repeat CT for the same symptoms without new clinical findings has a significantly lower yield (1.8%) compared to first-time examinations. 5