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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.
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.
The Electronic Curriculum is copyrighted 1998, Case Western Reserve University School of Medicine.