Two weeks later, he was able to stand and walk with the help of others. The neurological function of the patient continued to improve, and the patient was successfully changed from a supine position to the Fowler’s position within a few days. The next day, the head CT showed resolution of transtentorial herniation, a significant decrease in midline shift, and reappearance of basal cisterns (Figure 3A and B). However, the left side remained hemiplegia, and the right pupil dilated to 4 mm.
#BLOWN PUPIL TREATMENT CRANIECTOMY SKIN#
An urgent head CT revealed increasing midline shift, transtentorial herniation, and brainstem compression (Figure 2).Ī few hours later, with the sinking skin flap relieving, the neurological function of the patient was significantly improved, and consciousness returned. On the morning of the 7th d after the operation, after an intravenous drip of 50 g of mannitol in the Fowler’s position, the neurological function of the patient continued to deteriorate, the right pupil dilated to 4 mm and the left to 2 mm. Although the flap pressure was not high, 50 g of 20% mannitol was given every 8 h to reduce local edema. The CT angiography shows normal cerebral vessels (Figure 1G and H). The head CT shows that the hematoma has been completely cleared, and the midline is almost in the middle (Figure 1C and D). On the 1st d after the operation, the patient was fully awake with normal communication and directional movement of the right limb but had left hemiplegia. Postoperative pathological examination revealed malformed blood vessels (Figure 1E and F). A mass of abnormal blood vessels founded in the hematoma cavity during the operation was removed. The patient underwent an emergent frontoparietal decompressive craniectomy with a duraplasty, and the hematoma was completely evacuated. An urgent head computed tomography (CT) examination revealed massive right temporal hemorrhage (Figure 1A and B). The neurological examination showed a Glasgow Coma Scale score of 8 and a left hemiparesis. Two hours before his arrival, he suddenly developed weakness in his left limb and was unable to stand while working.
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