PMC5473084_01
(a) Computed tomography (CT) scan upon admission showing a hematoma in the basal cistern. (b) Anteroposterior view of the left internal carotid angiogram revealing an aneurysm at the bifurcation of the internal carotid artery and the posterior communicating artery. (c) CT on day 14 showing ventricular narrowing and low-density area on the left occipital lobe (arrowhead). (d-f) Magnetic resonance (MR) imaging showed fluid-attenuated inversion recovery (FLAIR) images depicting diffuse high-intensity lesions in the bilateral frontal, temporal, parietal, and occipital lobes, and basal ganglia, brainstem, and cerebellum. (g) MR angiography showing no significant vasospasm. (h) MR imaging obtained on day 30 showing a complete resolution of high-intensity lesions.
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F1
Computed tomography (CT) showed a subarachnoid hemorrhage (SAH) [Figure 1a]. Emergency angiography revealed a small aneurysm at the bifurcation of the left internal carotid artery and the posterior communicating artery [Figure 1b]. Emergency CT obtained 6 h after this episode revealed a ventricular narrowing compared to the previous CT images obtained before 2 days; in addition, a new, small, low-density area in the left occipital lobe was observed [Figure 1c]. Magnetic resonance (MR) images taken 9 h after the overdrainage showed diffuse hyper-intensity areas on FLAIR in the bilateral frontal, temporal, parietal, and occipital lobes, and basal ganglia, brainstem, and cerebellum [Figure 1d-f] without an apparent spasm on MR angiography [Figure 1g]. MR imaging performed on day 30 demonstrated a complete disappearance of edema delineated as FLAIR high lesions [Figure 1h].
PMC5473084_02
(a) CT scan demonstrating a large arachnoid cyst on the right frontotemporal region. (b) Immediate postoperative CT revealing a remarkable shrinkage of the cyst. (c) CT obtained 1 day after surgery showing low-density areas in the bilateral occipital lobes. (d) MR FLAIR image on the fourth day after surgery demonstrating diffuse high-intensity areas in the temporal, parietal, and occipital lobes on both sides, and in the right frontal lobe. (e) MR FLAIR image 27 days after surgery showing an almost complete disappearance of lesions
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F2
CT images showed an enlargement of the right frontotemporal arachnoid cyst [Figure 2a], which we considered the cause of her left hemiparesis. BP remained around 100/40 mmHg) or complications during the operation, the patient did not wake up after the anesthesia was completely terminated. Before the surgery, we had increased the valve pressure to 20 cmH2O because we were concerned about a rapid reduction in ICP; however, postoperative CT demonstrated remarkable shrinkage of the cyst with a small amount of bleeding [Figure 2b]. The emergency CT images showed low-density areas in the bilateral occipital lobes [Figure 2c], and MR imaging on the fourth day following surgery revealed diffuse hyper-intensity areas on FLAIR imaging in the temporal, parietal, and occipital lobes on both sides, and the right frontal lobe [Figure 2d]. MR images taken 27 days after surgery demonstrated an almost complete disappearance of edematous areas [Figure 2e].