Patient history
A 46-year-old Perth male presented to an after-hours radiology clinic having experienced a blackout prior to collapsing. He reported a continuing headache and a history of seizures.
Initial findings, diagnosis, and treatment
A head CT scan was performed at 10pm the same day. Default axial images appeared unremarkable, but a noticeable scalp hematoma was evident at the vertex. The radiology team used an existing decision-support AI tool, which did not detect any further abnormalities. The scans also revealed signs of a prior brain injury. The patient was reported to be having continued seizures and was hospitalized for monitoring and treatment.
Retrospective analysis
A retrospective analysis was conducted five days after the patient presented to the after-hours clinic, while the patient was still in hospital. A Clinical Director reviewed the case in conjunction with results from Annalise Enterprise CTB, a decision-support solution that detects up to 130 suspected clinical findings on non-contrast CT Brain studies.
The CTB Module indicated the suspected presence of:
- A fracture at the vertex
- Extra-axial hematoma related to the fracture
- Scalp hematoma

A. Original CT scan in the PACS viewer, blue arrow pointing to the fracture. B. Annalise Enterprise CT Brain output highlighting and localising the fracture.

C. Original CT scan in the PACS viewer, blue arrow pointing to the hematoma related to the fracture. D. Annalise Enterprise CT Brain Module output highlighting and localising the extra-axial hematoma.
Significance of findings
Undisplaced skull fractures can sometimes be missed on axial CT scans. Vertex extradural hematomas are uncommon and can also be difficult to diagnose on routine CT on the default axial images . Importantly, vertex fractures with extradural hematomas indicate a tear to the superior sagittal sinus which may be associated with significant morbidity and mortality if not identified promptly.
Dr. Peter Brotchie Associate Professor
St. Vincent’s Hospital Melbourne
Benefits of Annalise Enterprise CT Brain Analysis
Annalise Enterprise CT Brain Module is designed to assist clinicians to make fast, accurate decisions. It analyses each non-contrast CT brain image for up to 130 findings, which may be subtle, but life-threatening. By identifying the suspected extradural hematoma and superior sagittal sinus tear in this patient, the CT Brain module prompted further investigations to support diagnosis and effective treatment.
Dr. Peter Brotchie Associate Professor
St. Vincent’s Hospital Melbourne
Patient management post-CT Brain analysis
The onsite medical team was advised to reassess the patient urgently due to the potential implications of the superior sagittal sinus tear. A follow-up CT was performed to determine whether the hematoma had increased and to monitor its impact. The CT showed the bleeding had stopped and the hematoma had only minimally increased in size.
However, the medical team also conducted an MRI scan of the hematoma and area around the sagittal sinus, which revealed a thrombosis of the sinus.
Dr. Peter Brotchie Associate Professor
St. Vincent’s Hospital Melbourne

Original CT

CT 5 days later

CT 5 days later
Figure 2. CT scans at admission to the hospital (left) and after five days (middle). MRI scan after five days (right) Blue arrows pointing to the extra-axial hematoma.
The importance of early detection in summary
Identifying the vertex fracture indicated the need for more urgent patient management. The fracture’s location and further medical assessment suggested the patient had suffered significant head trauma. A superior sagittal sinus tear can be a neurosurgical emergency. The thrombosis would not have been detected on CT scan, with MRI imaging being indicated. If these findings remained undetected, the patient could have suffered brain herniation or death.
Dr. Peter Brotchie Associate Professor
St. Vincent’s Hospital Melbourne
The Annalise Viewer provides an intuitive and configurable user interface, automatically correcting for rotation and tilt, reformatting the image, and listing all suspected findings in the Annalise Viewer. Selection of a finding will provide a purple overlay in three planes, subcategorisation, differential diagnoses, and a confidence bar, if applicable. For simplicity, only the infarct and haemorrhage findings are shown here.
- Chawla H, Yadav RK, Griwan MS, Malhotra R, Paliwal PK. Sensitivity and specificity of CT scan in revealing skull fracture in medico-legal head injury victims. Australas Med J. 2015;8(7):235-238. Published 2015 Jul 31. doi:10.4066/AMJ.2015.2418
- Ramesh VG, Kodeeswaran M, Deiveegan K, Sundar V, Sriram K. Vertex epidural hematoma: An analysis of a large series. Asian J Neurosurg. 2017;12(2):167-171. doi:10.4103/1793-5482.145555
- Harbury OL, Provenzale JM, Barboriak DP. Vertex epidural hematomas: imaging findings and diagnostic pitfalls. Eur J Radiol. 2000;36(3):150-157. doi:10.1016/s0720-048x(00)00175-3iv Ben-Israel D, Isaacs AM, Morrish W, Gallagher NC. Acute vertex epidural hematoma. S
- Rivkin MA, Saraiya PV, Woodrow SI. Sinovenous thrombosis associated with skull fracture in the setting of blunt head trauma. Acta Neurochir (Wien). 2014 May;156(5):999-1007; discussion 1007. doi: 10.1007/s00701-014-2025-9. Epub 2014 Feb 27. PMID: 24573982.
Dr. Peter Brotchie is employed by annalise.ai. Annalise Enterprise CT Brain was used as part of a limited Control Product Launch where the product was used as part of routine clinical work. This information is intended for health care professionals only. Annalise Enterprise is not intended to provide direct diagnosis. For detailed device information, including indications for use, contraindications, precautions and warnings, please consult the user guide prior to use. Not all features are available in all regions. Check regulatory status with an annalise.ai employee or contact info@annalise.ai. Annalise Enterprise CTB is not for sale in the U.S.
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