case_images: PMC8202355_01
case_images: (a) (1 h) Basal cuts computed tomography scan showing SAH in distal right sylvian fissure (black arrow). (b) (1 h) Mid axial computed tomography scan showing thin layer of hypodensity (black arrow) seen between the inner table of bone and acute subdural hematoma with a midline shift. (c) (1 h) High parietal axial computed tomography scan showing thick acute subdural hematoma present at the high frontoparietal region with obliterated cortical sulci. (d) (6 h) basal axial cuts of computed tomography scan showed opened basal cistern with a resolution of the right sylvian SAH. (e and f) (6 h) Mid and high parietal axial computed tomography scan showing marked resolution of acute subdural hematoma seen, with reduction of midline shift
case_images: AJNS-16-33-g001.jpg
case_images: PMC8202355_01_AJNS-16-33-g001.jpg
case_images: F1
case_images: The computed tomography (CT scan) of head done at the previous hospital, 1 h after injury, showed 1.2 centimeters (cm) thick right sided acute subdural hematoma (ASDH) with 1 cm of midline shift to the left side [Figure 1a-c]. The repeat scan at our hospital (6 h after head injury) showed marked resolution of right side ASDH with reduction of midline shift to 0.3 cm [Figure 1d-f].
case_images: PMC8202355_02
case_images: (a-c) Computed tomography scan of basal cuts showing SAH in the right sylvian fissure(arrow) and right frontal sulci (broken arrow) (a), gradually resolve in day 3 (b) and day 6 (c). (d-f) computed tomography scan of mid-axial section of the brain acute subdural hematoma with mixed density clot with hypodensity around it (broken arrow) (d), which disappeared in day 3 (e) and Day 6 (f). (g-i) Sagittal image showing redistribution of clot acute subdural hematoma along the tentorium and falx on (broken arrow) day 2 (g), day 3 (h) and day 6 computed tomography (I). (j-l) The coronal image showing day 2 (J), 3 (k) and 6 (l) showed almost similar size right PCA infarct (broken arrow)
case_images: AJNS-16-33-g002.jpg
case_images: PMC8202355_02_AJNS-16-33-g002.jpg
case_images: F2
case_images: The 1st CT scan of the head was done at the time of admission, i.e., 24 h after trauma and showed ASDH of 1 cm thickness in the right frontotemporoparietal region, bilateral frontal contusion, subarachnoid hemorrhage, and evolving infarct in right posterior cerebral artery territory with midline shift of 0.82 cm to the left [Figure 2a, d]. The patient's clinical condition improved gradually and CT scan on day 3 and day 6 of trauma showed marked resolution of ASDH with reduction in midline shift to 0.2 cm [Figure 2b,c,e and f]. There was redistribution of clot to tentorium cerebelli and falx cerebelli, as seen on coronal and sagittal cuts of CT scan on day 2, 3 and 6 [Figure 2g-l].
case_images: PMC8202355_03
case_images: (6 h after trauma) (a) Basal axial image showing obliterated basal cistern with left basifrontal contusion. (b and c) (6 h after trauma)-9.6 mm mixed density SDH in left fronto-temporo-parietal region (marked with broken arrow) with midline shift of 6 mm (d-f) (13 h after trauma)-computed tomography scan showing complete resolution of mixed density part of clot with small residual hyperdense part of clot with open basal cistern and no midline shift. (g-i) (day 5 after trauma) Computed tomography scan showing resolving left basifrontal contusion and residual left frontal SDH
case_images: AJNS-16-33-g003.jpg
case_images: PMC8202355_03_AJNS-16-33-g003.jpg
case_images: F3
case_images: CT scan done approximately 6 h after trauma showed 9.6 mm mixed density subdural hematoma (SDH) in left fronto-temporo-parietal region, midline shift of 6 mm, obliterated basal cistern with left basifrontal contusion [Figure 3a-c]. CT scan repeated at our hospital, 13 h after trauma showed complete resolution of the mixed density part of SDH with minimal residual hyperdense SDH, no midline shift with open quadrigeminal and ambient cisterns [Figure 3d-f]. Repeat CT scan was done on day 5 of admission which showed small residual left frontal SDH and left basifrontal contusion with no mass effect and midline shift [Figure 3g-i].
case_images: PMC8202355_04
case_images: (a-c) (1 h after trauma) computed tomography scan showing 10 mm thick acute subdural hematoma with 7.3 mm midline shift and mixed density clot in frontal portion of subdural hematoma (marked with broken arrow). (d-f) (7 h after trauma) computed tomography scan showing marked resolution of acute subdural hematoma to 5 mm thickness and midline shift of 3 mm. Some redistribution of clot seen along the tentorium cerebelli (marked with broken arrow) (d). (g-i) (4th day of trauma) computed tomography scan showing complete resolution of clot with no midline shift
case_images: AJNS-16-33-g004.jpg
case_images: PMC8202355_04_AJNS-16-33-g004.jpg
case_images: F4
case_images: Mixed density clot was present in frontal portion of SDH [Figure 4a-c]. The frontal portion of clot was thin and completely hypodense and mixed density areas of clot had migrated to parietal region [Figure 4d-f]. Some redistribution of clot was also seen on tentorium, in the basal cuts of axial CT scan [Figure 4d]. The next CT scan was done on day 4 of trauma, which showed complete resolution of clot with no midline shift [Figure 4g-i].
case_images: PMC8202355_05
case_images: (a and b) (1 h after trauma) computed tomography scan showing thick right acute subdural hematoma, 12 mm of midline shift with subgaleal hematoma (marked with broken arrow). (c) (5 h after trauma) computed tomography scan showing significant reduction of acute subdural hematoma and midline shift with enlargement of subgaleal hematoma (marked with broken arrow)
case_images: AJNS-16-33-g005.jpg
case_images: PMC8202355_05_AJNS-16-33-g005.jpg
case_images: F5
case_images: Linear fracture was present in frontal bone with subgaleal hematoma of 6 cm x 2 cm size [Figure 5a and b]. It showed significant reduction of the right ASDH to 5 mm thickness, reduction of midline shift to 2 mm and enlargement of subgaleal hematoma size (9 cm x 2 cm size) Figure 5c].