PMC6417290_01
Computed tomography scan image shows a subdural collection on the right side with a lesser subdural collection on the left side. A midline brain shift is present
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F1
In consideration of the persistence of headache in clinostatism, we decided to perform a brain computed tomography (CT) scan, which showed a bilateral subdural hematoma, larger on the right side (12 mm) causing a left-sided brain shift of about 5.3 mm [Figure 1].
Computed tomography scan image: the subdural collection is increased in dimension with a higher density in the posterior part by persistent midline brain shift
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F2
CT scan which showed an increase in density of the subdural collection with an increase in brain shift [Figure 2]. Considering that the conservative treatment was not sufficient, we considered and proposed a subdural hematoma evacuation, which the patient accepted.
Postsurgical computed tomography scan control shows the evacuation of the collection with air in the anterior part and a reduction of midline brain shift
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F3
The postoperative CT scan showed the evacuation of the blood collection with reduction of the midline brain shift [Figure 3].
(a) shows the subdural collection with air inclusions (b) shows the important brain shift due to the collection (c) shows an increase in the subdural collection
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F4
A brain CT scan was performed demonstrating a reformation of the subdural hematoma on the right side larger than that one before surgery; hydration, analgesia, and bed rest were again implemented [Figure 4a and b]. Nine days after the intervention, a cranial CT showed a further increase of the subdural blood collection with brain shift [Figure 4c].
Control computed tomography scan shows no more subdural collection with no midline brain shift
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F5
Three months after surgical procedure, the patient was symptom free, and CT scan showed a complete resolution of the subdural hematoma without brain shift [Figure 5].