PMC5416770_01
A, Head computed tomography (CT) illustrating the intraventricular hemorrhage. The hematoma completely filled the third ventricle and had produced hydrocephalus. B, Postoperative intraventricular external drainage resulted in a significant decrease in the intraventricular hemorrhage. C, Enlargement of both the lateral ventricles with surrounding white matter edema is consistent with communicating hydrocephalus. D, Postoperative ventricle peritoneal shunt. E, The ventricular system was shrinking, and the periventricular edema disappeared. F-I, Axial and sagittal CT images showing severe, bilateral thickening of the inner table of the frontal bone with cortex compression. I, The outer table of the frontal bone was intact.
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Brain CT showed intraventricular hemorrhage and subarachnoid hemorrhage (Figure 1A). One week after surgery, cranial CT revealed that the ventricle hemorrhage had disappeared (Figure 1B), and the drain tube was removed. One month later, repeat head CT showed dilation of the entire ventricular system associated with communicating hydrocephalus (Figure 1C). A ventriculoperitoneal shunt insertion was recommended (Figure 1D). The neuroimaging findings revealed that the lateral ventricles were smaller than before (Figure 1E). The electroencephalogram revealed frequent, irregularly slow waves in the bilateral frontotemporal region. Brain CT showed severe, bilateral thickening of the inner table of the frontal bone with cortex compression (Figure 1F-I).
A, There were bilateral papilledema with hemorrhages. B and C, Intraoperative appearance of the frontal bone. D, Microscopic view of the histological specimen of hyperostosis frontalis interna. Hematoxylin and eosin staining; original magnification, x100.
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There was bilateral optic disc swelling, with hemorrhages of the optic nerve head and surrounding retina (Figure 2A). The inner table was honeycombed and red (Figure 2B and C), and the intracranial pressure was elevated. The pathological diagnosis revealed a hyperostosis frontalis interna (Figure 2D).
A-C, Postoperative brain computed tomography (CT) demonstrating that the frontal bone was removed and replaced with titanium mesh to relieve the brain compression.
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Baseline radiography of the skeletal system was performed and showed no additional foci of hyperostosis (Figure 3A-C).