PMC7749959_01
The left noncontrast head computed tomography (CT) scan, axial view, left parietal intraparenchymal hemorrhage on initial presentation. The right CT angiography on initial presentation revealing incidental right parietal arteriovenous malformation.
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F1
His blood pressure on presentation was 164/78 mmHg, and he was found to have a left parietal intraparenchymal hemorrhage and an incidental right parietal arteriovenous malformation [Figure 1].
Noncontrast head computed tomography scans, axial views. (a) Immediately post-external ventricular drain (EVD) placement. (b) Spontaneous tract hemorrhage 5 days post-EVD placement. Interval enlargement of the EVD tract hemorrhage with 6 days (c) and 8 days. (d) Post-EVD placement shown here. (e) Recombinant factor VII was given on post-EVD placement day 8 with stabilization of the tract hemorrhage on day 9. (f) Acute development of the right-sided subdural hemorrhage 10-day post-EVD placement.
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F2
Given the possibility of delayed hydrocephalus as explanation for his worsening encephalopathy, the patient was trialed on cerebrospinal fluid diversion with an EVD [Figure 2a]. The tract hemorrhage continued to increase in size over the next few days [Figure 2b-d]. A head CT performed a day later revealed stability of the tract hemorrhage [Figure 2d and e]. Repeat imaging revealed development of a new acute subdural hemorrhage [Figure 2f].