case_images: PMC6417330_01
case_images: Computed tomography brain plain - postoperative picture of pituitary macroadenoma. Mild hemorrhages are noted below the craniotomy site
case_images: AJNS-14-211-g001.jpg
case_images: PMC6417330_01_AJNS-14-211-g001.jpg
case_images: F1
case_images: Scale (GCS) of 15/15. Computed tomography (CT) scan done at this juncture was uneventful with only postoperative changes [Figure 1]. She had mild fever which manifested on the 4th postoperative day which lasted for few days and subsided.
case_images: Computed tomography brain plain - shows hematoma in the subcutaneous plain as well as in the left frontal extradural region causing mass effect and midline shift
case_images: AJNS-14-211-g002.jpg
case_images: PMC6417330_01_AJNS-14-211-g002.jpg
case_images: F2
case_images: A CT scan was repeated which showed subgaleal and extradural hematoma (EDH) beneath the craniotomy site with mild midline shift of 3 mm [Figure 2].
case_images: Computed tomography brain plain - after the first reexploration showing recollection of extradural hematoma in the left frontal extradural region causing mass effect and midline shift
case_images: AJNS-14-211-g003.jpg
case_images: PMC6417330_01_AJNS-14-211-g003.jpg
case_images: F3
case_images: A repeat CT scan was taken which showed recollection of EDH [Figure 3].
case_images: Computed tomography brain plain - showing further increase in the size of extradural hematoma in the left frontal extradural region causing severe mass effect and midline shift
case_images: AJNS-14-211-g004.jpg
case_images: PMC6417330_01_AJNS-14-211-g004.jpg
case_images: F4
case_images: But again, after 2 days she deteriorated in her consciousness and a repeat CT revealed the size of the EDH had further increased with mass effect on the brain [Figure 4].
case_images: Computed tomography brain plain after second reexploration showing significant decrease in the collection at the extradural site. The mass effect and midline shift has been resolved
case_images: AJNS-14-211-g005.jpg
case_images: PMC6417330_01_AJNS-14-211-g005.jpg
case_images: F5
case_images: A repeat CT scan was take after 3 days of second reexploration which showed that there was no further bleeding [Figure 5].
case_images: PMC6417330_02
case_images: Computed tomography brain plain - showing bilateral infarcts involving the cerebellum, there is patchy infarct involving the right temporal lobe. The temporal horns of the lateral ventricle as well as the fourth ventricle are dilated
case_images: AJNS-14-211-g006.jpg
case_images: PMC6417330_02_AJNS-14-211-g006.jpg
case_images: F6
case_images: A CT scan was advised which revealed bilateral cerebellar infarcts and patchy hypodensities in the left middle cerebral artery territory [Figures 6 and 7].
case_images: Computed tomography brain plain - showing rounding of the third ventricle and dilatation of the frontal and temporal horns of the lateral ventricle due to obstructive hydrocephalus
case_images: AJNS-14-211-g007.jpg
case_images: PMC6417330_02_AJNS-14-211-g007.jpg
case_images: F7
case_images: A CT scan was advised which revealed bilateral cerebellar infarcts and patchy hypodensities in the left middle cerebral artery territory [Figures 6 and 7].
case_images: Computed tomography brain plain - showing the external ventricular drain in situ with intracerebral hematoma in the left frontoparietal region with severe mass effect and midline shift
case_images: AJNS-14-211-g008.jpg
case_images: PMC6417330_02_AJNS-14-211-g008.jpg
case_images: F8
case_images: An urgent CT scan was taken which revealed a large intracerebral hematoma in the opposite cerebral hemisphere [Figure 8].
case_images: PMC6417330_03
case_images: Computed tomography brain plain - preoperative image showing hematoma in the right temporal and frontal regions with mass effect on the brain
case_images: AJNS-14-211-g009.jpg
case_images: PMC6417330_03_AJNS-14-211-g009.jpg
case_images: F9
case_images: After resuscitation, a CT scan was taken which showed a right temporal lobe hematoma [Figure 9].
case_images: Computed tomography brain plain - postoperative image showing resolution of the hematoma in the temporal lobe along with postoperative changes
case_images: AJNS-14-211-g010.jpg
case_images: PMC6417330_03_AJNS-14-211-g010.jpg
case_images: F10
case_images: Postoperative CT scan showed no fresh bleeding [Figure 10].
case_images: (a) Preoperative chest X-ray posteroanterior view showing clear lung fields. (b) Bilateral lung infiltrates in the setting of adult respiratory distress syndrome
case_images: AJNS-14-211-g011.jpg
case_images: PMC6417330_03_AJNS-14-211-g011.jpg
case_images: F11
case_images: After 4 days, her consciousness further deteriorated and chest X-rays revealed she had severe chest infection [Figure 11a and b].
case_images: PMC6417330_04
case_images: (a and b) Computed tomography brain plain - showing diffuse Subarachnoid hemorrhage along with intraventricular bleed
case_images: AJNS-14-211-g012.jpg
case_images: PMC6417330_04_AJNS-14-211-g012.jpg
case_images: F12
case_images: CT scan of the brain along with magnetic resonance imaging (MRI) of the spine was advised. CT scan revealed diffuse patchy subarachnoid hemorrhages involving both cerebral hemispheres along with intraventricular bleed [Figure 12a and b].
case_images: (a) Magnetic resonance imaging T1-weighted sagittal image showing diffuse hypointense signals with in the parenchyma of the spinal cord of T11-L1. The cord is also seen expanded in this region. (b) Contrast image showing no contrast enhancement of the lesion
case_images: AJNS-14-211-g013.jpg
case_images: PMC6417330_04_AJNS-14-211-g013.jpg
case_images: F13
case_images: The spinal cord was distended from T11 to L1 regions due to underlying hematoma [Figures 13 and 14].
case_images: (a) Magnetic resonance imaging T1-weighted axial image at the level of T12 vertebra showing isointense lesion in the spinal canal arising from the left side pushing the cord toward the right. (b) T1-weighted axial image at the level of L1 vertebra showing the isointense lesion arising from the left side of the spinal cord with mass effect
case_images: AJNS-14-211-g014.jpg
case_images: PMC6417330_04_AJNS-14-211-g014.jpg
case_images: F14
case_images: The spinal cord was distended from T11 to L1 regions due to underlying hematoma [Figures 13 and 14].
case_images: Intraoperative image-showing T12 and L1 laminectomy. The spinal cord is seen expanded at the region of the T12 with underlying bluish blush of the hematoma
case_images: AJNS-14-211-g015.jpg
case_images: PMC6417330_04_AJNS-14-211-g015.jpg
case_images: F15
case_images: The cord was seen swollen with underlying bluish blush of the hematoma [Figure 15].