PMC9217157_01
Computed tomography (CT) scan upon admission revealed a right-sided frontal subdural hematoma with mass effect and midline shift (A, B). No base of the skull fracture or pneumocephalus was noted, and CSF leakage was not obvious (C, D).
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The head CT scan revealed a right-sided frontal subdural hematoma with mass effect and midline shift (Fig. 1A&B). No base of skull fracture or pneumocephalus was noted, and CSF leakage was not obvious (Fig. 1C&D).
CT scan obtained after the operation revealed that the subdural hematoma was successfully removed (A), with no obvious abnormalities, aside from low-density lesions in both thalami (B).
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Scale (GCS) score of 8. Subsequently, another head CT scan was performed, which confirmed that the subdural hematoma had been successfully removed (Fig. 2A&B), with no other obvious abnormalities noted aside from low-density lesions in both thalami (Fig. 2B).
Magnetic resonance imaging revealed areas of high intensity on diffusion-weighted imaging (A), whereas apparent diffusion coefficient showed low intensity in both thalami (B), and susceptibility-weighted imaging showed bleeding in the same area. Dilation of the cortical veins suggestive of venous infarction was not observed (C). There was fluid-attenuated inversion recovery hyperintensity in the basal ganglia, thalamus, brainstem, and cerebellum, similar to hypoxic encephalopathy (D, E). Magnetic resonance angiography and venography revealed no abnormalities (F, G, H). Arterial spin labeling (ASL) showed an increase in perfusion of the right frontal lobe and brainstem on postoperative day (POD) 1 (I), but the ASL imaged on POD 4 showed no difference between the left and right sides (J).
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On postoperative day (POD) 1, his consciousness was still impaired, and he developed new-onset seizures; therefore, a head MRI was conducted, which revealed bilateral thalamic hemorrhages (Fig. 3A-C) and fluid-attenuated inversion recovery hyperintensity in the basal ganglia, thalamus, brainstem, and cerebellum similar to those in hypoxic encephalopathy (Fig. 3D&E). The intracranial and extracranial arteries and cerebral veins exhibited no apparent changes radiologically (Fig. 3F-H), and no dilation of the cortical veins suggestive of venous infarction was observed (Fig. 3C). Arterial spin labeling (ASL) showed an increase in perfusion of the right frontal lobe and brainstem on POD 1 (Fig. 3I), but ASL on POD 4 revealed no difference in perfusion between the left and right sides (Fig. 3J).