PMC6417317_01
At the time of admission, brain computed tomography showed no specific findings at the level of the basal cistern (a). At the level of foramen semiovale, a small amount of acute subdural hematoma on the right side with minimal brain shift was noted (b, arrowheads). A computed tomography after neurologic deterioration showing a high density at the level of the basal cistern (c, arrowheads) and subacute subdural hematoma which increased markedly causing severe brain distortion (d, asterisk)
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F1
The brain computed tomography (CT) showed no specific findings at the level of basal cistern [Figure 1a]. However, it showed a thin acute SDH of the right side with brain shift of < 5 mm [Figure 1b], and he was admitted to a neurosurgical ward for observation. A brain CT revealed an isodensity SDH with a midline shift of >10 mm [Figure 1d]. Review of the previous CT revealed a high density around the basal cistern, which had been overlooked [Figure 1c, arrowheads].
A postoperative computed tomography showing lack of improvement in brain shift despite the evacuation of hematoma (a). Accumulation of intracranial air was noted (asterisk). A computed tomography obtained a month after discharge showing reversal of brain shift (b)
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F2
Despite the surgery, he failed to improve neurologically, and postoperative CT showed that there was no improvement in the brain shift [Figure 2a]. Accumulation of intracranial air was also noted [Figure 2a, asterisk]. A brain CT performed 1 month after discharge showed a reversal of brain shift [Figure 2b].
Computed tomography myelography showing the dural sleeve of the left L2 nerve root as the source of cerebrospinal fluid leakage (arrowheads: a, axial image; b, sagittal image)
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F3
A CT myelography revealed the dural sleeve of the right L2 nerve root as the source of CSF leakage [Figure 3a and b].