case_images: PMC4732258_01
case_images: Case 1: (a) Noncontrast computerised tomography axial images of 29-year-old male following road traffic accident developed intraparenchymal contusion (broad arrow) showing hemorrhagic contusion in right frontotemporoparietal lobe causing transfalcine herniation with midline shift. SDH was seen in right frontal region. (b) Axial bone window sections showing fracture of right frontotemporoparietal bone (long arrow) with depressed fracture involving right orbital roof (not shown)
case_images: AJNS-11-74b-g001.jpg
case_images: PMC4732258_01_AJNS-11-74b-g001.jpg
case_images: F1
case_images: Non-contrast CT scan of head [Figure 1] revealed hemorrhagic contusion in right frontotemporoparietal lobe with transfalcine herniation with midline shift of 7 mm and a subdural hematoma in the right frontal region.
case_images: Case 1: Magnetic resonance imaging done on 2nd postoperative day showing lesion around (broad arrow) right sylvian fissure. (a) T1-weighted image showing isointense lesion abutting insular cortex (thin yellow arrow). (b) T1-weighted image showing hyperintense lesion with hypointense rim on lateral aspect. Surrounding hyperintense edema (star) was present. (c) Flash image showing blooming on medial aspect of the lesion (white arrow) representing bleed. (d-f) B500 and B1000 image showing no diffusion restriction (yellow arrow)
case_images: AJNS-11-74b-g002.jpg
case_images: PMC4732258_01_AJNS-11-74b-g002.jpg
case_images: F2
case_images: Case 1: Patient presented for cranioplasty after 2 months of operation. Noncontrast computerised tomography followed by contrast-enhanced computerised tomography was done. (a and b) Noncontrast computerised tomography showed two similar appearing well defined hyperdense lobulated mass. One measuring approximately 2.2 cm x 1.5 cm around right sylvian fissure is seen abutting insular cortex with surrounding gliotic changes and another rounded hyperdense mass noted in right temporal lobe (long arrow in a and b). (c and d) Axial postcontrast brain sections showing prominent peripheral enhancement of lesions in insular cortex and temporal lobe (broad yellow arrow in c and d)
case_images: AJNS-11-74b-g003.jpg
case_images: PMC4732258_01_AJNS-11-74b-g003.jpg
case_images: F3
case_images: Prior to procedure, preoperative noncontrast computerised tomography (NCCT) followed by contrast-enhanced computerised tomography (CECT) scan of the head [Figure 3] was done which revealed a well-defined hyperdense lobulated mass of size approximately 2.2 cm x 1.5 cm in right insular cortex location.
case_images: (a) Case 1: Axial T1-weighted image showing two well defined lobulated mass around right sylvian fissure abutting insular cortex (arrow) which is hypo to isointense. (b) T2-weighted axial image showing the hyperintense mass surrounded by hypointense rim. (c) Axial fluid-attenuated inversion-recoveryimage showing hyperintense mass with surrounding hypointense rim (thin arrow) (d and e) diffusion-weighted image at B1000 and ADC. Core of the lesion is not showing restriction of diffusion however surrounding rim shows restriction. (f) Postcontrast image showing peripheral enhancement (thin arrow). The core of lesion is not enhancing
case_images: AJNS-11-74b-g004.jpg
case_images: PMC4732258_01_AJNS-11-74b-g004.jpg
case_images: F4
case_images: So to further characterize contrast enhanced MRI was done [Figures 4 and 5].
case_images: Case 1: (a) Axial T1-weighted image showing another rounded mass in right temporal lobe (yellow arrow) which is hypointense and surrounded by iso- to hyper-intense rim. (b) T2-weighted image shows hyperintense core surrounded by hypointense rim (thin white arrow). (c and d) On diffusion weighted image and corresponding ADC, the core of the lesions does not shows diffusion restriction. (e) Contrast was administered and it shows prominent peripheral enhancement in the lesions (thin arrow). (f) Peroperative image showing gauzoma
case_images: AJNS-11-74b-g005.jpg
case_images: PMC4732258_01_AJNS-11-74b-g005.jpg
case_images: F5
case_images: So to further characterize contrast enhanced MRI was done [Figures 4 and 5].
case_images: PMC4732258_02
case_images: Case 2: Decompressive craniectomy was done for subdural hematoma involving left parietal lobe. Patient complain of memory loss for which computerized tomography followed by Magnetic resonance imaging was done. (a) Noncontrast computerised tomography show rounded hyperdense lesion (yellow arrow) in left frontal location. (b) contrast-enhanced computerised tomography shows prominent periphery enhancement. (c) Axial T1-weighted image of brain shows iso- to hypo-intense lesion in left frontal lobe (d and e) T2-weighted and fluid-attenuated inversion-recovery axial image showing hyper- to iso-intense lesion with surrounding hypointense rim (thin white arrow). (f) Postgadolinium image shows diffuse nodular enhancement (yellow arrow)
case_images: AJNS-11-74b-g006.jpg
case_images: PMC4732258_02_AJNS-11-74b-g006.jpg
case_images: F6
case_images: NCCT followed by CECT of head [Figure 6a and b] was done initially which showed well defined rounded hyperdense lesion in left frontal lobe with peripheral enhancement possibility of foreign body granuloma, resolving hematoma, and abscess were kept as differential diagnosis following CT.