PMC4770122_01
(a) Axial plain CT scan at the time of admission shows left acute subdural hematoma and bilateral frontal contusion with thickness of 14 mm and midline shift of 8 mm. There is a bruised area in the right parietal region without bone fracture. (b) Axial plain CT scan 72 hours after admission shows worsened acute subdural hematoma with thickness of 16 mm and midline shift of 9 mm. Massive contusion of the left frontal lobe has occurred. (c) Radiographic frontal view shows the location of the burr hole 4 cm above the left eyebrow. (d) Axial plain CT scan after surgery shows reduced hematoma. Midline shift had improved to 4 mm. There is a small amount of air in the subdural space. Burr hole is covered by bone powders.
CRINM2016-2056190.001.jpg
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fig1
Coma Scale (GCS) score was 13 (E4V4M5). Computed tomography (CT) scanning revealed left ASDH and bilateral frontal contusion with a thickness of 14 mm and a midline shift (MLS) of 8 mm (Figure 1(a)). Glycerol (1600 mL/day) was administered to reduce edema, but the 72-hour CT showed massive contusion of the left frontal lobe and the MLS had increased to 9 mm (Figure 1(b)). In total, 40% of the hematoma was removed, and the MLS was improved to 4 mm after the procedure (Figures 1(c) and 1(d)).
PMC4770122_02
(a) Axial plain CT scan at the time of admission shows right acute subdural hematoma and right frontal and temporal contusion with thickness of 10 mm and midline shift of 6 mm. There is a bruised area in the left temporal region without bone fracture. (b) Axial plain CT scan 48 hours after admission showed massive contusion and uncal herniation. The midline shift has worsened to 9 mm. (c) Most hematoma was removed and midline shift was completely resolved. The massive contusion in the right frontal lobe was reduced. The information drain was inserted into the subdural space. (d) Radiographic frontal view shows location of the burr hole 3 cm above the right eyebrow.
CRINM2016-2056190.002.jpg
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fig2
CT scanning showed right ASDH and right frontal and temporal contusion with a thickness of 10 mm and an MLS of 6 mm (Figure 2(a)). But the CT after 48 hours showed edema around the contusion and uncal herniation with anisocoria (Figure 2(b)). In total, 70% of the hematoma was removed, and the MLS improved completely (Figures 2(c) and 2(d)).