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Missing Brain s/p Craniectomy

A 36 year old man suffered an ischemic stroke with the acute onset of a left sided hemiplegia. Within a day, he was stuporous. To save this life and prevent herniation, a right craniectomy was performed. Two years later, the patient had never returned to have the bone flap replaced.

Outline the MCA Infarction   Show the Midline Shift   Show the Craniectomy Site   Show the "Missing Brain"

Axial CT scans: (Left) Acute, massive right middle cerebral stroke with shift and impending herniation; (B) s/p craniectomy - note a large piece of skull has been removed to allow the brain to swell and prevent herniation - note also the dark areas that indicate air in the wound following surgery; (C): Two years later - note the large area of missing brain surrounded by a thin layer of scalp tissue.

Revised 05/07/06.
The Electronic Curriculum is copyrighted 1998,  Case Western Reserve University School of Medicine.