PMC5820867_01
(a) Noncontrast computed tomography head (NCCT) (on the day of ictus): Showing intraparenchymal bleed in the right frontotemporal region. (b) NCCT head (25 days after decompressive craniectomy) shows increased brain bulge and ventriculomegaly. (c) NCCT head (41 days after decompressive craniectomy) shows settled brain bulge and decompressed ventricles after ventriculopleural shunt. (d) NCCT head (48 days after decompressive craniectomy) shows decompressed ventricles post cranioplasty and residual brain edema in the right frontotemporal region. (e) Contrast-enhanced computed tomography head (150 days after decompressive craniectomy) shows contrast enhancement along the dural margin at the site of craniotomy. (f) NCCT head (151 days after decompressive craniectomy) shows decompressed ventricles and no brain bulge immediately after the removal of bone flap. (g) NCCT head (160 days after decompressive craniectomy) shows sinking brain and chinked ventricles (after which shunt was ligated). (h) NCCT head (162 days after decompressive craniectomy) shows brain bulge and ventriculomegaly after shunt ligation. (i) NCCT head (165 days after decompressive craniectomy) shows settling brain bulge and decompressed ventricles after conversion from medium pressure to high-pressure ventriculopleural shunt
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F1
On evaluation, he was found to have large right frontotemporal hematoma [Figure 1a] secondary to ruptured right middle cerebral artery aneurysm. After initial improvement for 2 weeks, the patient deteriorated in clinical status in the 3rd week and computed tomography [Figure 1b] showed ventriculomegaly. Following shunt, the patient improved clinically and repeat CT head [Figure 1c] revealed decompressed ventricles. The patient improved clinically as well as radiologically [Figure 1d]. Approximately, 3 months later, he got admitted with persistent discharge from the wound site and contrast-enhanced computed tomography head [Figure 1e] suggested underlying infection. CT head [Figure 1f] was satisfactory at this stage. CT head [Figure 1g] revealed sinking flap and midline shift to the contralateral side. Attributing it to shunt over drainage, the shunt was immediately tied and then changed to high pressure [Figure 1h]. Although patient made gradual recovery with [Figure 1i] the correction of ventricle size, he never regained same neurological status.