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Technical InformationImaging study date and time // (24 hour clock) Imaging modality (choose one): FORMCHECKBOX Non-contrast CT FORMCHECKBOX X-Ray Angiography FORMCHECKBOX Contrast CT FORMCHECKBOX MRI FORMCHECKBOX CT AngiographyImaging scanner strength (choose one): FORMCHECKBOX 1.5T FORMCHECKBOX 3.0T FORMCHECKBOX 4.0T FORMCHECKBOX 7.0T FORMCHECKBOX Other, specify:Imaging scanner manufacturer name (choose one): FORMCHECKBOX Agfa FORMCHECKBOX Hitachi FORMCHECKBOX Philips FORMCHECKBOX Other, specify FORMCHECKBOX Carestream FORMCHECKBOX Hologic FORMCHECKBOX Siemens FORMCHECKBOX GE FORMCHECKBOX Konica Minolta FORMCHECKBOX ToshibaImaging scanner model nameImaging scanner software version numberImaging sequence (choose all that apply): FORMCHECKBOX T1 FORMCHECKBOX DWI FORMCHECKBOX DTI FORMCHECKBOX Other, specify FORMCHECKBOX T2 FORMCHECKBOX GRE FORMCHECKBOX MRSI FORMCHECKBOX FLAIR FORMCHECKBOX SWI FORMCHECKBOX PWIFindings*Brain imaging result (choose one): FORMCHECKBOX Normal FORMCHECKBOX Abnormal FORMCHECKBOX Not done FORMCHECKBOX UnknownIf answered #8 “Normal,” “Not done,” or “Unknown,” skip remaining questionsSkull fracture (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX AbsentEpidural hematoma (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX AbsentExtraaxial hematoma (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX AbsentAcute subdural hematoma (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX AbsentSubacute or chronic subdural hematoma (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX AbsentSubdural hematoma - mixed density or CSF-like collection (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX AbsentSubarachnoid hemorrhage(choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX AbsentVascular dissection (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX AbsentTraumatic aneurysm (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX AbsentVenous sinus injury (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX AbsentMidline shift supratentorial (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX AbsentCisternal compression (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX AbsentIf answered #20 “Indeterminate,” or “Absent,” skip to question 22.Cisternal compression type FORMCHECKBOX Visible but compressed - Asymmetric FORMCHECKBOX Visible but compressed - Symmetric FORMCHECKBOX Mixed (some cisterns open, others compressed/obliterated) FORMCHECKBOX Obliterated (all cisterns)Fourth ventricle shift or effacement (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX Absent Contusion (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX Absent If answered #23 “Indeterminate,” or “Absent,” skip to question 25.Contusion findings (choose all that apply) FORMCHECKBOX Hemorrhagic FORMCHECKBOX Subcortical FORMCHECKBOX Non-hemorrhagic FORMCHECKBOX Probable brain laceration (linear hemorrhagic or non-hemorrhagic pattern, often associated with overlying skull fracture) Intracerebral hemorrhage (choose one): FORMCHECKBOX Deep brain structures FORMCHECKBOX Cortical FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX Absent Intraventricular hemorrhage (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX Absent Diffuse axonal injury (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX Absent If answered #26 “Indeterminate,” or “Absent,” skip to question 28.Diffuse axonal injury anatomic site (choose all that apply): FORMCHECKBOX Frontal – L FORMCHECKBOX Frontal - R FORMCHECKBOX Parietal - R FORMCHECKBOX Temporal - R FORMCHECKBOX Occipital - R FORMCHECKBOX Thalamus/Basal ganglia – R FORMCHECKBOX Midbrain - R FORMCHECKBOX Pons - R FORMCHECKBOX Medulla - R FORMCHECKBOX Cerebellum - R FORMCHECKBOX Corpus Callosum: Genu - R FORMCHECKBOX Corpus Callosum: Body - R FORMCHECKBOX Corpus Callosum: Splenium - R FORMCHECKBOX Subcortical White matter: Frontal - R FORMCHECKBOX Subcortical White matter: Parietal - R FORMCHECKBOX Subcortical White matter: Temporal - R FORMCHECKBOX Subcortical White matter: Occipital - R FORMCHECKBOX Internal Capsule: Anterior limb - R FORMCHECKBOX Internal Capsule: Posterior limb -R FORMCHECKBOX Brainstem: Dorsolateral rostral - R FORMCHECKBOX Brainstem: other - R FORMCHECKBOX Cerebellar Peduncles – R FORMCHECKBOX Parietal – L FORMCHECKBOX Temporal – L FORMCHECKBOX Occipital – L FORMCHECKBOX Thalamus/Basal ganglia – L FORMCHECKBOX Midbrain – L FORMCHECKBOX Pons – L FORMCHECKBOX Medulla –L FORMCHECKBOX Cerebellum – L FORMCHECKBOX Corpus Callosum: Genu – L FORMCHECKBOX Corpus Callosum: Body – L FORMCHECKBOX Corpus Callosum: Splenium – L FORMCHECKBOX Subcortical White matter: Frontal – L FORMCHECKBOX Subcortical White matter: Parietal – L FORMCHECKBOX Subcortical White matter: Temporal – L FORMCHECKBOX Subcortical White matter: Occipital – L FORMCHECKBOX Internal Capsule: Anterior limb – L FORMCHECKBOX Internal Capsule: Posterior limb –L FORMCHECKBOX Brainstem: Dorsolateral rostral - L FORMCHECKBOX Brainstem: other – L FORMCHECKBOX Cerebellar Peduncles – LPenetrating injury (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX AbsentIf answered #28 “Indeterminate,” or “Absent,” skip to question 30.Penetrating injury associated findings (choose all that apply): FORMCHECKBOX Indriven fragments (bone, foreign bodies) FORMCHECKBOX Through and through trajectory (entrance and exit sites) FORMCHECKBOX Transventricular trajectory FORMCHECKBOX Crosses midlineGunshot wound caliber numberCervicomedullary junction or brainstem injury (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX AbsentIf answered #31 “Indeterminate,” or “Absent,” skip to question 33. Cervicomedullary junction or brainstem injury anatomic site (choose all that apply): FORMCHECKBOX Midbrain FORMCHECKBOX Pons FORMCHECKBOX Medulla FORMCHECKBOX CervicalEdema (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX AbsentBrain swelling (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX AbsentIf answered #34 “Indeterminate,” or “Absent,” skip to question 36. Brain swelling extent (choose one): FORMCHECKBOX Focal FORMCHECKBOX Hemispheric FORMCHECKBOX Global FORMCHECKBOX Lobar FORMCHECKBOX Bihemispheric FORMCHECKBOX Multilobar FORMCHECKBOX Posterior fossaIschemia or infarction or hypoxic-ischemic injury (choose one): FORMCHECKBOX Present FORMCHECKBOX Indeterminate FORMCHECKBOX AbsentBrain atrophy or encephalomalacia (choose one): FORMCHECKBOX Present FORMCHECKBOX Likely FORMCHECKBOX Indeterminate FORMCHECKBOX AbsentAdditional Supplemental Elements:Marshall CT classification code (Choose one) FORMCHECKBOX 1; Diffuse injury, NVP: Intracranial pathology not visible on CT scan FORMCHECKBOX 2; Diffuse injury: Cisterns present with shift 0-5 mm, lesions present, but no high or mixed density lesion >25 cc. May include bone fragments and foreign bodies FORMCHECKBOX 3; Diffuse injury with swelling: Cisterns compressed or absent, shift 0-5 mm, no high or mixed density lesion >25 cc; FORMCHECKBOX 4; Diffuse injury with shift: Shift >5 mm, no high or mixed density lesion >25 cc. FORMCHECKBOX 5; Mass lesions: High or mixed density lesion > 25cc.Skull fracture (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateSkull fracture anatomic site (Choose all that apply)Frontal FORMCHECKBOX R FORMCHECKBOX LParietal FORMCHECKBOX R FORMCHECKBOX LTemporal FORMCHECKBOX R FORMCHECKBOX LOccipital FORMCHECKBOX R FORMCHECKBOX LSkull base FORMCHECKBOX R FORMCHECKBOX LAnterior fossa FORMCHECKBOX Middle fossa FORMCHECKBOX Posterior fossa FORMCHECKBOX Skull fracture morphology findings type (Choose all that apply) FORMCHECKBOX Depressed (>1 cm or full thickness of skull) FORMCHECKBOX Ping pong fracture –(Smooth depression typically seen in infants and toddlers, without a complete bony cortical disruption) FORMCHECKBOX Diastatic (Separated more than 3 mm, or separation of a suture) FORMCHECKBOX Compound (Communication with the skin, mastoid air cells, or paranasal sinuses) FORMCHECKBOX Penetrating (Resulting from an indriven foreign body, such as knife or missile) FORMCHECKBOX Probable fracture –(One in which fracture itself cannot be seen definitively, but is suspected to be present based on other findings such as adjacent subgaleal and extra-axial hemorrhage, intracranial air, or other findings) FORMCHECKBOX Pneumocephalus (Pneumocephalus – Present) FORMCHECKBOX Other craniofacial fractures – (For children <3 years, of interest for relevance for inflicted injuries) FORMCHECKBOX Linear (Includes simple and branched) FORMCHECKBOX Comminuted (Involving at least one separate non-contiguous bone segment)Epidural hematoma (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateEpidural hematoma anatomic site (Choose all that apply)Frontal FORMCHECKBOX R FORMCHECKBOX LParietal FORMCHECKBOX R FORMCHECKBOX LTemporal FORMCHECKBOX R FORMCHECKBOX LOccipital FORMCHECKBOX R FORMCHECKBOX LPosterior fossa FORMCHECKBOX R FORMCHECKBOX LEpidural hematoma volume measurement:cm3Epidural hematoma findings type (Choose all that apply) FORMCHECKBOX Likely venous (due to association with adjacent bony injury/fracture, venous sinus, size, distribution, timing) FORMCHECKBOX Likely arterial (due to "swirl", different densities, location near major dural artery)Extraaxial hematoma (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateExtraaxial hematoma anatomic siteFrontal FORMCHECKBOX R FORMCHECKBOX LParietal FORMCHECKBOX R FORMCHECKBOX LTemporal FORMCHECKBOX R FORMCHECKBOX LOccipital FORMCHECKBOX R FORMCHECKBOX LInterhemispheric supratentorial FORMCHECKBOX Anterior (frontoparietal) FORMCHECKBOX Posterior (occip)Tentorial FORMCHECKBOX R FORMCHECKBOX LPosterior fossa FORMCHECKBOX R FORMCHECKBOX LExtraaxial hematoma volume measurement:cm3Acute subdural hematoma (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateSubdural hematoma acute anatomic site (Choose all that apply)Frontal FORMCHECKBOX R FORMCHECKBOX LParietal FORMCHECKBOX R FORMCHECKBOX LTemporal FORMCHECKBOX R FORMCHECKBOX LOccipital FORMCHECKBOX R FORMCHECKBOX LInterhemispheric supratentorial FORMCHECKBOX Anterior (frontoparietal) FORMCHECKBOX Posterior (occip)Tentorial FORMCHECKBOX R FORMCHECKBOX LPosterior fossa FORMCHECKBOX Interhemispheric infratentorial R FORMCHECKBOX Interhemispheric infratentorial LSubdural hematoma acute volume measurement:cm3Subdural hematoma acute type (Choose one) FORMCHECKBOX Heterogeneous (i.e. mixed density) FORMCHECKBOX HomogeneousSubacute or chronic subdural hematoma (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateSubdural hematoma subacute or chronic anatomic site (Choose all that apply)Frontal FORMCHECKBOX R FORMCHECKBOX LParietal FORMCHECKBOX R FORMCHECKBOX LTemporal FORMCHECKBOX R FORMCHECKBOX LOccipital FORMCHECKBOX R FORMCHECKBOX LInterhemispheric FORMCHECKBOX Anterior (frontoparietal) FORMCHECKBOX Posterior (occip)Tentorial FORMCHECKBOX R FORMCHECKBOX LPosterior fossa FORMCHECKBOX R FORMCHECKBOX LSubdural hematoma subacute or chronic volume measurement:cm3Subdural hematoma subacute or chronic findings type (Choose all that apply) FORMCHECKBOX Heterogeneous FORMCHECKBOX Loculations/Septations FORMCHECKBOX HomogeneousSubdural hematoma – mixed density or CSF-like collection (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateSubdural hematoma mixed density or CSF-like collection anatomic site (Choose all that apply)Frontal FORMCHECKBOX R FORMCHECKBOX LParietal FORMCHECKBOX R FORMCHECKBOX LTemporal FORMCHECKBOX R FORMCHECKBOX LOccipital FORMCHECKBOX R FORMCHECKBOX LInterhemispheric FORMCHECKBOX Anterior (frontoparietal) FORMCHECKBOX Posterior (occip)Tentorial FORMCHECKBOX R FORMCHECKBOX LPosterior fossa FORMCHECKBOX R FORMCHECKBOX LSubdural hematoma mixed density or CSF-like collection volume measurement:cm3Subdural hematoma mixed density or CSF-like collection findings type (Choose all that apply) FORMCHECKBOX Hyperintense/dense FORMCHECKBOX Isointense/dense FORMCHECKBOX Hypointense/denseSubarachnoid hemorrhage (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateSubarachnoid hemorrhage anatomic site (Choose all that apply)Frontal FORMCHECKBOX R FORMCHECKBOX LParietal FORMCHECKBOX R FORMCHECKBOX LTemporal FORMCHECKBOX R FORMCHECKBOX LOccipital FORMCHECKBOX R FORMCHECKBOX LInterhemispheric FORMCHECKBOX Anterior (frontoparietal) FORMCHECKBOX Posterior (occip)Suprasellar Tentorial FORMCHECKBOX R FORMCHECKBOX LPosterior fossa FORMCHECKBOX R FORMCHECKBOX LPerimesencephalic FORMCHECKBOX Subarachnoid hemorrhage extent type (Choose one) FORMCHECKBOX Diffuse (Involving more than two contiguous lobes or brain regions, supra- and infratentorical compartments, or multiple basal cisterns) FORMCHECKBOX Focal (In 1-2 locations or lobes of the brain)Subarachnoid hemorrhage findings type (Choose all that apply) FORMCHECKBOX Linear FORMCHECKBOX Mass-like (>3mm thickness, splaying of Sylvian fissure or other cistern) FORMCHECKBOX Acute hydrocephalusVascular dissection (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateVascular dissection anatomic site (Choose all that apply)Carotid FORMCHECKBOX R FORMCHECKBOX LVertebral FORMCHECKBOX R FORMCHECKBOX LOther FORMCHECKBOX R FORMCHECKBOX LCervical FORMCHECKBOX R FORMCHECKBOX LIntracranial FORMCHECKBOX R FORMCHECKBOX LVascular dissection site type (Choose one) FORMCHECKBOX Intracranial FORMCHECKBOX CervicalVascular dissection extent type (Choose one) FORMCHECKBOX Luminal narrowing greater than 50% (including "string sign") FORMCHECKBOX Vessel occlusion FORMCHECKBOX Luminal narrowing less than 50%Vascular dissection findings type (Choose one) FORMCHECKBOX Watershed or embolic infarction in the territory of the dissected vessel with SAH FORMCHECKBOX Watershed or embolic infarction in the territory of the dissected vessel without SAH FORMCHECKBOX Adjacent skull fracture (e.g. carotid canal)Traumatic aneurysm (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateTraumatic aneurysm anatomic site (Choose all that apply)Carotid FORMCHECKBOX R FORMCHECKBOX LVertebral FORMCHECKBOX R FORMCHECKBOX LACA FORMCHECKBOX R FORMCHECKBOX LMCA FORMCHECKBOX R FORMCHECKBOX LPCA FORMCHECKBOX R FORMCHECKBOX LBasilar FORMCHECKBOX Other (Describe): FORMCHECKBOX R FORMCHECKBOX LTraumatic aneurysm volume measurement:mm3Traumatic aneurysm findings type (Choose one) FORMCHECKBOX Intraluminal thrombus FORMCHECKBOX Cavernous (intradural) FORMCHECKBOX Skull fracture, with penetrating injury FORMCHECKBOX Skull fracture, without penetrating injuryVenous sinus injury (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateVenous sinus injury morphology type (Choose all that apply) FORMCHECKBOX Compression FORMCHECKBOX Occlusion FORMCHECKBOX LacerationVenous sinus injury anatomic site (Choose all that apply)Sagittal sinus FORMCHECKBOX Posterior (occipital) FORMCHECKBOX Anterior (frontoparietal)Transverse sinus FORMCHECKBOX R FORMCHECKBOX LSigmoid sinus FORMCHECKBOX R FORMCHECKBOX LMidline shift supratentorial (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateMidline shift supratentorial measurement:mmSide of the midline shift FORMCHECKBOX Right-to-left FORMCHECKBOX Left-to-rightCisternal compression laterality type FORMCHECKBOX Right FORMCHECKBOX Left FORMCHECKBOX Bilateral FORMCHECKBOX Midline FORMCHECKBOX UnknownCisternal compression anatomic site (Choose all that apply for each abnormal cistern) FORMCHECKBOX Perimesencephalic cistern FORMCHECKBOX Suprasellar cistern FORMCHECKBOX Cisterna magna FORMCHECKBOX Prepontine cistern FORMCHECKBOX Superior cerebellar cisternVentricle- fourth shift or effacement status (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateVentricle - fourth shift or effacement measurement:mmVentricle - fourth shift or effacement displacement type FORMCHECKBOX Right-to-left FORMCHECKBOX Left-to-right FORMCHECKBOX Anterior FORMCHECKBOX PosteriorVentricle - fourth shift or effacement findings type FORMCHECKBOX Brainstem compression FORMCHECKBOX HydrocephalusContusion Status (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateContusion anatomic site (Choose all that apply. List each lesion as a separate entry.)Frontal FORMCHECKBOX R FORMCHECKBOX LParietal FORMCHECKBOX R FORMCHECKBOX LTemporal FORMCHECKBOX R FORMCHECKBOX LOccipital FORMCHECKBOX R FORMCHECKBOX LInternal Capsule FORMCHECKBOX R FORMCHECKBOX LThalamus/Basal Ganglia FORMCHECKBOX R FORMCHECKBOX LMidbrain FORMCHECKBOX R FORMCHECKBOX LPons FORMCHECKBOX R FORMCHECKBOX LMedulla FORMCHECKBOX R FORMCHECKBOX LCerebellum FORMCHECKBOX R FORMCHECKBOX LContusion volume measurement:cm3Contusion findings type FORMCHECKBOX Non-hemorrhagic FORMCHECKBOX Cortical FORMCHECKBOX Subcortical FORMCHECKBOX Deep brain structure FORMCHECKBOX Probable brain laceration (linear hemorrhagic or non hemorrhagic pattern, often associated with overlying skull fracture) FORMCHECKBOX HemorrhagicIntracerebral hemorrhage indicator (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateIntracerebral hemorrhage anatomic site (Choose all that apply)Frontal FORMCHECKBOX R FORMCHECKBOX LParietal FORMCHECKBOX R FORMCHECKBOX LTemporal FORMCHECKBOX R FORMCHECKBOX LOccipital FORMCHECKBOX R FORMCHECKBOX LInternal Capsule FORMCHECKBOX R FORMCHECKBOX LThalamus/Basal Ganglia FORMCHECKBOX R FORMCHECKBOX LMidbrain FORMCHECKBOX R FORMCHECKBOX LPons FORMCHECKBOX R FORMCHECKBOX LMedulla FORMCHECKBOX R FORMCHECKBOX LCerebellum FORMCHECKBOX R FORMCHECKBOX LIntracerebral hemorrhage hemorrhagic component volume measurement:cm3Intracerebral hemorrhage entire lesion volume measurement:cm3Intracerebral hemorrhage findings type FORMCHECKBOX Surrounding ring of non-hemorrhagic signal (edema) FORMCHECKBOX Layered (i.e., with fluid level)Intraventricular hemorrhage status (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateIntraventricular hemorrhage anatomic site (Choose all that apply) FORMCHECKBOX Lateral ventricle--R FORMCHECKBOX Lateral ventricle--L FORMCHECKBOX Third ventricle FORMCHECKBOX Fourth ventricleIntraventricular hemorrhage ventriculomegaly status (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateIntraventricular hemorrhage volume measurement:cm3Intraventricular hemorrhage pattern type FORMCHECKBOX Obstructive FORMCHECKBOX Non-obstructiveDiffuse axonal injury status (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateTraumatic axonal injury status (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateDiffuse axonal injury and traumatic axonal injury anatomic site (Choose all that apply)Frontal FORMCHECKBOX R FORMCHECKBOX LParietal FORMCHECKBOX R FORMCHECKBOX LTemporal FORMCHECKBOX R FORMCHECKBOX LOccipital FORMCHECKBOX R FORMCHECKBOX LThalamus/Basal Ganglia FORMCHECKBOX R FORMCHECKBOX LMidbrain FORMCHECKBOX R FORMCHECKBOX LPons FORMCHECKBOX R FORMCHECKBOX LMedulla FORMCHECKBOX R FORMCHECKBOX LCerebellum FORMCHECKBOX R FORMCHECKBOX LCorpus Callosum: Genu FORMCHECKBOX R FORMCHECKBOX LCorpus Callosum: Body FORMCHECKBOX R FORMCHECKBOX LCorpus Callosum: Splenium FORMCHECKBOX R FORMCHECKBOX LSubcortical White matter: Frontal FORMCHECKBOX R FORMCHECKBOX LSubcortical White matter: Parietal FORMCHECKBOX R FORMCHECKBOX LSubcortical White matter: Temporal FORMCHECKBOX R FORMCHECKBOX LSubcortical White matter: Occipital FORMCHECKBOX R FORMCHECKBOX LInternal Capsule: Anterior limb FORMCHECKBOX R FORMCHECKBOX LInternal Capsule: Posterior limb FORMCHECKBOX R FORMCHECKBOX LBrainstem: Dorsolateral rostral FORMCHECKBOX R FORMCHECKBOX LBrainstem: Other FORMCHECKBOX R FORMCHECKBOX LCerebellar Peduncles FORMCHECKBOX R FORMCHECKBOX LDiffuse axonal injury and traumatic axonal injury lesions numberPenetrating injury brain status (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminatePenetrating injuries deepest extent penetrated anatomic site FORMCHECKBOX Scalp FORMCHECKBOX Skull FORMCHECKBOX Dura FORMCHECKBOX ParenchymaPenetrating injuries anatomic site (Choose all that apply)Frontal FORMCHECKBOX R FORMCHECKBOX LParietal FORMCHECKBOX R FORMCHECKBOX LTemporal FORMCHECKBOX R FORMCHECKBOX LOccipital FORMCHECKBOX R FORMCHECKBOX LInternal Capsule FORMCHECKBOX R FORMCHECKBOX LThalamus/Basal Ganglia FORMCHECKBOX R FORMCHECKBOX LMidbrain FORMCHECKBOX R FORMCHECKBOX LPons FORMCHECKBOX R FORMCHECKBOX LMedulla FORMCHECKBOX R FORMCHECKBOX LCerebellum FORMCHECKBOX R FORMCHECKBOX LGunshot wound caliber number:Penetrating injury associated findings (Choose all that apply) FORMCHECKBOX Through and through trajectory (entrance and exit sites) FORMCHECKBOX Transventricular trajectory FORMCHECKBOX Crosses midline FORMCHECKBOX Indriven fragments (bone, foreign bodies)Cervicomedullary junction or brainstem injury (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateCervicomedullary junction or brainstem injury anatomic site FORMCHECKBOX Midbrain FORMCHECKBOX Pons FORMCHECKBOX Medulla FORMCHECKBOX CervicalCervicomedullary junction or brainstem injury type (Choose one) FORMCHECKBOX Subtotal FORMCHECKBOX TotalEdema (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateEdema anatomic site (Choose all that apply)Frontal FORMCHECKBOX R FORMCHECKBOX LParietal FORMCHECKBOX R FORMCHECKBOX LTemporal FORMCHECKBOX R FORMCHECKBOX LOccipital FORMCHECKBOX R FORMCHECKBOX LDeep grey matter FORMCHECKBOX R FORMCHECKBOX LCerebellum FORMCHECKBOX R FORMCHECKBOX LBrainstem FORMCHECKBOX Edema extent type (Choose all that apply) FORMCHECKBOX Focal FORMCHECKBOX Lobar FORMCHECKBOX Multilobar FORMCHECKBOX Hemispheric FORMCHECKBOX Bihemispheric FORMCHECKBOX Posterior fossa FORMCHECKBOX GlobalEdema findings type (Choose all that apply) FORMCHECKBOX Cytotoxic FORMCHECKBOX Vasogenic FORMCHECKBOX Interstitial FORMCHECKBOX Osmotic FORMCHECKBOX IndeterminateEdema volume measurement:cm3Brain swelling (Choose one) FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX IndeterminateBrain swelling anatomic site (Choose all that apply)Frontal FORMCHECKBOX R FORMCHECKBOX LParietal FORMCHECKBOX R FORMCHECKBOX LTemporal FORMCHECKBOX R FORMCHECKBOX LOccipital FORMCHECKBOX R FORMCHECKBOX LDeep grey matter FORMCHECKBOX R FORMCHECKBOX LCerebellum FORMCHECKBOX R FORMCHECKBOX LBrainstem FORMCHECKBOX Brain swelling extent FORMCHECKBOX Focal FORMCHECKBOX Lobar FORMCHECKBOX Hemispheric FORMCHECKBOX Bihemispheric FORMCHECKBOX Posterior fossa FORMCHECKBOX GlobalIschemia or infarction or hypoxic-ischemic injury (Choose one) FORMCHECKBOX Absent FORMCHECKBOX Indeterminate FORMCHECKBOX PresentIschemia or infarction or hypoxic-ischemic injury anatomic site (Choose all that apply)Frontal FORMCHECKBOX R FORMCHECKBOX LParietal FORMCHECKBOX R FORMCHECKBOX LTemporal FORMCHECKBOX R FORMCHECKBOX LOccipital FORMCHECKBOX R FORMCHECKBOX LDeep grey matter FORMCHECKBOX R FORMCHECKBOX LCerebellum FORMCHECKBOX R FORMCHECKBOX LBrainstem FORMCHECKBOX Ischemia or infarction or hypoxic-ischemic injury extent type (Choose one) FORMCHECKBOX Focal FORMCHECKBOX Lobar FORMCHECKBOX Multilobar FORMCHECKBOX Hemispheric FORMCHECKBOX Bihemispheric FORMCHECKBOX Posterior fossa FORMCHECKBOX GlobalIschemia or infarction or hypoxic-ischemic injury, acute or subacute findings type (Choose all that apply) FORMCHECKBOX Isodense (for CT) FORMCHECKBOX Hyperdense (for CT) FORMCHECKBOX Hypointense (for MRI) FORMCHECKBOX Isointense (for MRI) FORMCHECKBOX Bright (for MRI) FORMCHECKBOX Normal (for MRI) FORMCHECKBOX Mixed (for CT or MRI) FORMCHECKBOX Hypodense (for CT)Ischemia or infarction or hypoxic-ischemic injury pattern type (Choose one) FORMCHECKBOX Arterial FORMCHECKBOX Lacunar FORMCHECKBOX Venous FORMCHECKBOX Global FORMCHECKBOX Dissection FORMCHECKBOX Mixed FORMCHECKBOX Indeterminate FORMCHECKBOX WatershedBrain atrophy or encephalomalacia FORMCHECKBOX Present FORMCHECKBOX Absent FORMCHECKBOX Likely FORMCHECKBOX IndeterminateBrain atrophy or encephalomalacia anatomic site (Choose all that apply)Frontal FORMCHECKBOX R FORMCHECKBOX LParietal FORMCHECKBOX R FORMCHECKBOX LTemporal FORMCHECKBOX R FORMCHECKBOX LOccipital FORMCHECKBOX R FORMCHECKBOX LDeep grey matter FORMCHECKBOX R FORMCHECKBOX LCerebellum FORMCHECKBOX R FORMCHECKBOX LHippocampus FORMCHECKBOX R FORMCHECKBOX LSupratentorial white matter (corpus callosum, periventricular white matter) FORMCHECKBOX R FORMCHECKBOX LBrain volumetric analysis measurement:cm3*Element is classified as Core ................
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