PMC10280603_01
Case 1: A 38-year-old man presented with unconsciousness. (A) A brain computed tomography (CT) scan obtained on admission shows no brain edema. (B) A brain CT on admission shows no compression to the midbrain. (C) Eleven hours after admission, bilateral pupil dilation was noted. The CT scan shows prominent cerebral edema. (D) Change in serum glucose and insulin dosage.
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An initial head CT scan did not reveal any abnormalities (Figure 1A,B). Because head CT showed marked cerebral edema (Figure 1C), the patient underwent ventricular drainage and intracranial pressure (ICP) sensor placement urgently, resulting in an initial ICP of 90 mmHg. Treatment and serum glucose trends are shown in Figure 1D.
PMC10280603_02
Case 2: A 25-year-old woman presented with impaired consciousness. (A, B) A brain computed tomography (CT) scan obtained on admission showing narrowed ventricles and an area of high density in the basal cistern, suggesting subarachnoid hemorrhage. (C) A 3D CT angiogram on admission shows a right middle cerebral artery aneurysm (yellow arrowhead). (D, E) Postoperative findings. Intraoperative brain edema was severe, and external decompression was carried out. (F) Change in serum glucose and insulin dosage.
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A head CT scan showed cerebral edema and a high-density area in the subarachnoid and basal cistern (Figure 2A,B). Because the 3D CT angiogram showed a right middle cerebral artery aneurysm (Figure 2C), emergency craniotomy was performed to clip the aneurysm. No subarachnoid hemorrhage or aneurysm was noted intraoperatively in the middle cerebral artery; therefore, external decompression was carried out and ICP was monitored to treat the cerebral edema (Figure 2D,E). Blood glucose correction was faster than the rate recommended by the guidelines (Figure 2F).