PMC8422440_01
Preoperative imaging of the head and brain. Magnetic resonance imaging of the brain shows a sagittal T1 sequence hyperintense rim and heterointense core (a) and a T2 fluid-attenuated inversion recovery sequence revealing a hyperintense (b) lesion. Diffusion restricting (c) and apparent diffusion coefficient (d) images, respectively, demonstrate a hyperintense and hypointense lesion. Computed tomography images of the head with (e) and without (f) contrast enhancement highlight a hyperdense lesion in the left temporal region.
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F1
Brain MRI was obtained as part of an outpatient workup 2 weeks following symptom onset, and the sagittal T1 sequence revealed an abnormal rim - hyperintense core - heterointense lesion on the sagittal T1 sequence [Figure 1a]. Fluid-attenuated inversion recovery (FLAIR) T2 sequence more specifically revealed a 6 cm x 3.6 cm x 3 cm hyperintense [Figure 1b], diffusion restricting, and apparent diffusion coefficient hypointense extra-axial collection without surrounding edema [Figure 1c and d]. Significant mass effect on the temporal lobe and left midbrain [Figure 1b] was observed, and the patient was referred to the emergency department for further evaluation. Contrast-enhanced CT of the head was obtained to assess for the progression or change in the lesion observed on MRI and demonstrated the similar contrast rim-enhancing lesion with significant surrounding mass effect [Figure 1e and f].
Operative photograph of thick hematoma capsule with fibrosis. The thick epidural hematoma capsule that was found after the bone flap was removed after craniotomy.
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F2
Instead, a rather thick, yellow fibrous-like tissue was observed [Figure 2].
Postoperative follow-up imaging. (a and b) Serial axial computed tomography head images without contrast enhancement demonstrating resolution of the left temporal epidural hematoma.
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F3
At the 6-week postoperative follow-up visit, he had near-complete resolution of his diplopia and complete resolution of his epidural hematoma on head CT [Figure 3a and b].