PMC7451141_01
(a) Noncontrast computed tomography (CT) head on initial presentation to emergency department, demonstrating small right subdural hematoma. (b) Noncontrast CT head on hospital day 2 demonstrating expansion of the right subdural hematoma.
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F1
Noncontrast CT of the head [Figure 1a] was significant for a 6 mm right frontal SDH with no shift, as well as a right medial orbital wall fracture. On the 2nd hospital day, he developed severe headache, and the head CT was repeated [Figure 1b], which showed worsening of the SDH with associated mass effect and 2 mm midline shift.
(a) Noncontrast computed tomography (CT) head on representation for headache. Expansion of hematoma to 15 mm with 8 mm midline shift. (b) Noncontrast CT head after burr hole craniotomy to evacuate subdural hematoma, showing improvement in mass effect and midline shift.
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F2
The patient was still neurologically intact at this time, and repeat CT head [Figure 2a] showed expansion of the hematoma to 15 mm, with increased mass effect and 8 mm midline shift. Following hematoma evacuation, the patient's headache improved, and the SDH decreased in size on repeat CT head [Figure 2b].
Noncontrast computed tomography head showing 5.2 cmx3.3 cm intraparenchymal hemorrhage
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F3
CTA head [Figure 3] showed right frontal intraparenchymal hemorrhage measuring 5.2 cmx3.3 cm but no vascular lesion or anomaly. Cerebral catheter angiography was then performed and [Figure 4a and b] showed prominence of the anterior temporal branch of the right middle cerebral artery with early, rapid, shunting of blood through a cortical vein to the superior sagittal sinus.
(a and b) Cerebral angiogram showing early filling of draining vein of arteriovenous malformations (AVM). (c and d) Postembolization cerebral angiogram with no filling of draining vein of AVM.
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F4
CTA head [Figure 3] showed right frontal intraparenchymal hemorrhage measuring 5.2 cmx3.3 cm but no vascular lesion or anomaly. Cerebral catheter angiography was then performed and [Figure 4a and b] showed prominence of the anterior temporal branch of the right middle cerebral artery with early, rapid, shunting of blood through a cortical vein to the superior sagittal sinus. The embolization was successful and no opacification of the early draining vein or AVM nidus were seen [Figure 4c and d].