PMC4508685_01
Serial changes in head computed tomography (CT). Head CT revealed the formation of hematoma (arrowheads). Brain edema had progressed continuously at least until 13 days after the injury. a: on admission; b: 3 hours after admission; c: hospital day 7; d: day 10; e and f: day 13 (plain and enhanced CT, respectively).
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F1
Her consciousness was impaired (Glasgow coma scale [GCS], 4-4-6), and a brain contusion was detected in the left temporal lobe by head computed tomography (CT) (Fig. 1a). Her disturbance of consciousness gradually exacerbated, and a head CT 3 hours after admission revealed the formation of an intracerebral hematoma (Fig. 1b). As the level of ICP remained stable at around 10 mmHg and device-related intracranial infection was suspected, the ICP sensor was removed on day 10, although the brain edema was slightly increased compared with that on hospital day 7 (Fig. 1c, d). On hospital day 13, the edema increased further (Fig. 1e), and an enhanced CT showed ring enhancement of the hematoma (Fig. 1f).
Head magnetic resonance imaging (MRI) on day 25. Brain edema is shown as a high signal intensity (arrowheads) on fluid-attenuated inversion recovery (FLAIR) imaging.
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F2
On hospital Day 25, head magnetic resonance imaging (MRI) showed the edematous lesion mainly in white matter as a high-intensity signal on fluid-attenuated inversion recovery (FLAIR) imaging (Fig. 2) but not on diffusion-weighted imaging (data not shown), indicating that the edema was vasogenic.