case_images: PMC10783690_01
case_images: Non-contrast computed tomography scan. (a) Bilateral hemispheric hypodensity with preservation of posterior fossa was seen, consistent with a "big black brain" (b) Preservation of central nuclei was also seen, along with a left hemispheric crescentic lesion, suggestive of a subdural hematoma. (c) The hypodense lesion was also seen up to the vertex region.
case_images: SNI-14-427-g001.jpg
case_images: PMC10783690_01_SNI-14-427-g001.jpg
case_images: F1
case_images: A non-contrast head CT scan revealed a subacute SDH on the left parietal and occipital lobe along with hypodensity in both hemispheres with preservation of posterior fossa, consistent with hemispheric hypodensity (the "big black brain") [Figure 1].
case_images: Hinge craniotomy. (a) After a "three-sided craniotomy," periosteal on the temporal base was preserved. A craniectomy on the temporal base was performed to improve the decompression size. A blue dura mater was seen. (b) After subdural blood clot removal, the brain was bulging with engorgement of the cortical vein. The bone was then left at the initial site without any fixation to maintain a "hinged" position.
case_images: SNI-14-427-g002.jpg
case_images: PMC10783690_01_SNI-14-427-g002.jpg
case_images: F2
case_images: We performed a hinge craniotomy and subdural blood clot removal after stabilization [Figure 2].
case_images: Post-operative non-contrast head computed tomography scan two months following surgery. (a) There was an extensive hypodense lesion on the cortical region, as well as dilatation of the temporal horn (b) The extensive hypodense lesion on the cortical was also seen along with dilatation of the lateral ventricle. "Hinged" bone could be found on the left side. (c) The cortical hypodense lesion was also identified up to the vertex region, but relatively less than the preoperative finding.
case_images: SNI-14-427-g003.jpg
case_images: PMC10783690_01_SNI-14-427-g003.jpg
case_images: F3
case_images: However, two months following the operation, a control CT scan indicated substantial brain atrophy in both hemispheres [Figure 3].