PMC8202376_01
Initial brain nonenhanced computed tomography images of the patient. Brain computed tomography showed chronic subdural hematoma with minimal amount acute subdural hemorrhage and midline shift
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F1
A nonenhanced brain computed tomography (CT) revealed a left chronic subdural hematoma [Figure 1].
Follow-up brain computed tomography image 12 days after the operation. Brain computed tomography showed recurrence of left subdural hematoma
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A follow-up brain CT [Figure 2] revealed recurrence of the left subdural hematoma with a small amount of acute hemorrhage.
Follow-up brain computed tomography image showed recurrence of left subdural hematoma with midline shift
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Follow-up brain CT showed recurrence of the hemorrhage [Figure 3].
Follow-up brain computed tomography image showed subacute subdural hematoma with midline shift
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Follow-up brain CT showed mixed subdural hemorrhage and increased fluid collection at the site of the preexisting subdural hemorrhage [Figure 4].
(a) Clinical photo of the patient during decompressive craniectomy with duroplasty. (b) Follow-up brain computed tomography image after decompressive craniectomy showing improvement of midline shift
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F5
After confirming bleeding cessation, duroplasty was performed using an artificial dura (Surgisis Biodesign Dural Graft, COOK Medical 7 cm x 10 cm), and the operation was complete [Figure 5].
Angiography showing thickened left middle meningeal artery. (a) Angiography of the left middle meningeal artery. (b) Embolization of the left middle meningeal artery was performed completely
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F6
Hemorrhagic spread to additional subdural areas was not noted, although the left middle meningeal artery was unusually thickened [Figure 6a]; complete embolization with histoacryl and lipiodol was successfully performed [Figure 6b].
Follow-up brain computed tomography image of the patient showing left epidural hematoma compressing the brain
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Brain compression by the hemorrhage was also noted [Figure 7].
Brain computed tomography image before patient discharge. No hemorrhage and midline shift were noticed
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After the operation, the patient returned to an alert state, maintained ambulation, and was discharged after a follow-up brain CT scan confirming resolution of the hemorrhage [Figure 8].