PMC7395526_01
Sequential head CT examinations in a 55-year-old man with severe traumatic brain injury. At the time of admission (a-c), massive acute subdural hematoma above the right cerebral convexity causing prominent brain shift with subfalcine and transtentorial herniation, the obliteration of basal cisterns, as well as diffuse subarachnoid hemorrhage were seen. Immediately after surgery directed at the evacuation of subdural hematoma, right temporal lobectomy, and external decompression (d-f), the "re-appeared" ambient cistern can be clearly visualized, as well as wide area of infarction within the right parietal and occipital lobes caused by compression of the posterior cerebral artery at the time of herniation, and subcutaneous hematoma. At the time of discharge after cranioplasty and ventriculoperitoneal shunting (g-i), asymmetric hydrocephalus, extensive infarction of the right parietal and occipital lobes, and small epidural CSF collection are evident, as well as absence of the right temporal muscle (arrows), which was resected at the time of decompressive surgery.
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Head CT revealed massive acute subdural hematoma above the right cerebral convexity causing prominent brain shift with subfalcine and transtentorial herniation, the obliteration of basal cisterns, as well as diffuse subarachnoid hemorrhage [Figure 1a-c]. Immediately after surgery, CT demonstrated significant reduction of the brain shift, "reappearance" of the ambient cistern, large area of infarction within the right parietal and occipital lobes caused by compression of the posterior cerebral artery at the time of herniation, and subcutaneous hematoma [Figure 1d-f]. At that time, his GCS score was 4T4 (eye opening, 4; verbal response, tracheostomy; and motor response, 4) and CT demonstrated asymmetric hydrocephalus, extensive infarction of the right parietal and occipital lobes, and small epidural CSF collection in the right temporoparietal area [Figure 1g-i].