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CASE OF THE MONTH

SEPTEMBER 2023

Submitted by Aditya Bharatha MD FRCPC and Amy Chen MD FRCPC, Division of Neuroradiology, St. Michael’s Hospital, Unity Health, University of Toronto.

35M post-craniectomy for hemorrhagic transformation of right MCA infarct. Increasing bulge at craniectomy site.

Post-op CT from 2 days earlier

0.064T Hyperfine Swoop portable MRI at bedside

Anchor 1
Anchor 2

DIAGNOSIS

pMRI Findings:

  • Increased external herniation of brain through right craniectomy site with “mushrooming” of brain tissue.

  • Right frontoparietal residual hemorrhage and edema extending to right basal ganglia.

  • Stable ventricular size.

  • New mild rightward midline shift.

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Diagnosis: Increased / excessive external brain herniation through craniectomy site with mushrooming and ipsilateral shift. Managed with contralateral EVD.

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Followup CT confirming worsening external brain herniation and mild rightward midline shift. Placement of EVD into contralateral lateral ventricle.

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