PMC10481858_01
Precranioplasty computed tomography scan shows a sunken skin flap with a contralateral midline shift suggestive of a significant effect of the atmospheric pressure on the brain.
SNI-14-271-g001.jpg
PMC10481858_01_SNI-14-271-g001.jpg
F1
Ashworth Grade II hypertonia and Medical Research Council Grade 3 power in the left upper and lower limbs. A computed tomography (CT) scan revealed a sunken skin flap with a 9 mm midline shift to the left along with gliotic changes in the right MCA territory [Figure 1].
(a-c) Axial, sagittal, and coronal computed tomography scan images immediately after the procedure showing malignant bihemispheric cerebral edema with microhemorrhages. (d-f) Axial brain window, axial bone window, and a scout image showing the custom titanium mold in situ.
SNI-14-271-g002.jpg
PMC10481858_01_SNI-14-271-g002.jpg
F2
There was poor grey-white matter differentiation in the contralateral (left) side with a midline shift of 5 mm toward the right (cranioplasty) side [Figure 2].
Post procedure magnetic resonance imaging revealed bilateral posterior circulation hemorrhagic infarcts and severe edema. Diffusion-weighted imaging showing diffusion restricting acute infarcts (a and b), decreased apparent diffusion coefficient (c), and blooming on gradient echo sequence (d).
SNI-14-271-g003.jpg
PMC10481858_01_SNI-14-271-g003.jpg
F3