case_images: PMC11041977_01
case_images: Axial view of the CT showing left-sided extracranial cerebral herniation and retained bullet fragments.
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case_images: She was noted to have left-sided extracranial cerebral herniation in the area of impact (Figure 3), and a subarachnoid hemorrhage (Figure 4) in addition to a subdural hematoma on initial CT imaging.
case_images: Axial view of the CT showing subarachnoid hemorrhage.
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case_images: She was noted to have left-sided extracranial cerebral herniation in the area of impact (Figure 3), and a subarachnoid hemorrhage (Figure 4) in addition to a subdural hematoma on initial CT imaging.
case_images: Axial view of the head CT. (Yellow arrow: right-sided lateral sphenoid wall fracture due to force of penetrating trauma).
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case_images: Given the severe impact, she also developed multiple skull base fractures on the right side including the sphenoid wall laterally (Figure 5: axial view) (Figure 6: sagittal view) and anteriorly (Figure 7), the medial wall of the maxillary sinus and the medial sphenoid septum (Figure 8).
case_images: Sagittal view of the head CT. (Yellow arrow: right sided lateral sphenoid wall fracture due to force of penetrating trauma).
case_images: OAEM-16-75-g0006.jpg
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case_images: Given the severe impact, she also developed multiple skull base fractures on the right side including the sphenoid wall laterally (Figure 5: axial view) (Figure 6: sagittal view) and anteriorly (Figure 7), the medial wall of the maxillary sinus and the medial sphenoid septum (Figure 8).
case_images: Axial view of the head CT. (Yellow arrow: right sided anterior sphenoid wall fracture due to force of penetrating trauma).
case_images: OAEM-16-75-g0007.jpg
case_images: PMC11041977_01_OAEM-16-75-g0007.jpg
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case_images: Given the severe impact, she also developed multiple skull base fractures on the right side including the sphenoid wall laterally (Figure 5: axial view) (Figure 6: sagittal view) and anteriorly (Figure 7), the medial wall of the maxillary sinus and the medial sphenoid septum (Figure 8).
case_images: Axial view of the head CT. (Upper arrow: maxillary sinus medial wall fracture due to force of penetrating trauma) (Lower arrow: medial sphenoid septum fracture due to force of penetrating trauma).
case_images: OAEM-16-75-g0008.jpg
case_images: PMC11041977_01_OAEM-16-75-g0008.jpg
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case_images: Given the severe impact, she also developed multiple skull base fractures on the right side including the sphenoid wall laterally (Figure 5: axial view) (Figure 6: sagittal view) and anteriorly (Figure 7), the medial wall of the maxillary sinus and the medial sphenoid septum (Figure 8).
case_images: Axial view of the head CT showing VP shunt placement, right to left cerebral midline shift, and external brain herniation.
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case_images: A Ventriculo-peritoneal (VP) shunt placement a week later due to right-to-left cerebral herniation with a 13mm midline shift secondary to elevated intracranial pressures with dilated ventricles and no new hemorrhage (Figure 9).       
case_images: Axial view of the head CT with contrast showing a pseudoaneurysm of the cavernous portion of the right internal carotid artery protruding into the ethmoidal sinus.
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case_images: Within 10 minutes of stabilization, a computed tomography (CT) image of the head was completed, which revealed a progressive, expansile heterogeneous density mass in the posterior right ethmoidal sinus measuring 4.4 cm in diameter (Figures 10 and 11).
case_images: Sagittal view of the head CT with contrast showing a pseudoaneurysm of the cavernous portion of the right internal carotid artery protruding into the ethmoidal sinus.
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case_images: Within 10 minutes of stabilization, a computed tomography (CT) image of the head was completed, which revealed a progressive, expansile heterogeneous density mass in the posterior right ethmoidal sinus measuring 4.4 cm in diameter (Figures 10 and 11).
case_images: Cerebral angiogram showing large pseudoaneurysm of the cavernous portion of the internal carotid artery.
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case_images: Cerebral angiogram revealed the large pseudoaneurysm and confirmed its origin from the cavernous portion of the carotid artery (Figure 12).
case_images: Cerebral angiogram showing ONYX embolization and endovascular coiling of pseudoaneurysm.
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case_images: ONYX embolization was performed, followed by endovascular coiling with Raymond-Roy Occlusion Classification (RROC) grade I in case the Onyx was unsuccessful (Figure 13).
case_images: Sagittal view of the head CT showing persistent occlusion of the pseudoaneurysm and internal carotid artery patency.
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case_images: At her 1 month follow-up, repeat CT angiography revealed patency of the internal carotid artery and persistent occlusion of the pseudoaneurysm (Figure 14).