case_images: PMC7451141_01
case_images: (a) Noncontrast computed tomography (CT) head on initial presentation to emergency department, demonstrating small right subdural hematoma. (b) Noncontrast CT head on hospital day 2 demonstrating expansion of the right subdural hematoma.
case_images: SNI-11-203-g001.jpg
case_images: PMC7451141_01_SNI-11-203-g001.jpg
case_images: F1
case_images: Noncontrast CT of the head [Figure 1a] was significant for a 6 mm right frontal SDH with no shift, as well as a right medial orbital wall fracture. On the 2nd hospital day, he developed severe headache, and the head CT was repeated [Figure 1b], which showed worsening of the SDH with associated mass effect and 2 mm midline shift.
case_images: (a) Noncontrast computed tomography (CT) head on representation for headache. Expansion of hematoma to 15 mm with 8 mm midline shift. (b) Noncontrast CT head after burr hole craniotomy to evacuate subdural hematoma, showing improvement in mass effect and midline shift.
case_images: SNI-11-203-g002.jpg
case_images: PMC7451141_01_SNI-11-203-g002.jpg
case_images: F2
case_images: The patient was still neurologically intact at this time, and repeat CT head [Figure 2a] showed expansion of the hematoma to 15 mm, with increased mass effect and 8 mm midline shift. Following hematoma evacuation, the patient's headache improved, and the SDH decreased in size on repeat CT head [Figure 2b].
case_images: Noncontrast computed tomography head showing 5.2 cmx3.3 cm intraparenchymal hemorrhage
case_images: SNI-11-203-g003.jpg
case_images: PMC7451141_01_SNI-11-203-g003.jpg
case_images: F3
case_images: CTA head [Figure 3] showed right frontal intraparenchymal hemorrhage measuring 5.2 cmx3.3 cm but no vascular lesion or anomaly. Cerebral catheter angiography was then performed and [Figure 4a and b] showed prominence of the anterior temporal branch of the right middle cerebral artery with early, rapid, shunting of blood through a cortical vein to the superior sagittal sinus.
case_images: (a and b) Cerebral angiogram showing early filling of draining vein of arteriovenous malformations (AVM). (c and d) Postembolization cerebral angiogram with no filling of draining vein of AVM.
case_images: SNI-11-203-g004.jpg
case_images: PMC7451141_01_SNI-11-203-g004.jpg
case_images: F4
case_images: CTA head [Figure 3] showed right frontal intraparenchymal hemorrhage measuring 5.2 cmx3.3 cm but no vascular lesion or anomaly. Cerebral catheter angiography was then performed and [Figure 4a and b] showed prominence of the anterior temporal branch of the right middle cerebral artery with early, rapid, shunting of blood through a cortical vein to the superior sagittal sinus. The embolization was successful and no opacification of the early draining vein or AVM nidus were seen [Figure 4c and d].