Figure 1

Computed tomography of subdural hematoma and cerebral magnetic resonance imaging depicting early uncal herniation and mesiotemporal ischemic brain injury. (A) Preoperative cranial computed tomography scan reveals space-occupying subdural hematoma covering the left convexity. The hematoma causes a considerable midline shift at the level of the lateral ventricles. (B) Early diffusion- weighted magnetic resonance imaging (diffusion-weighted imaging) depicts a slight uncal herniation and a midline deviation at the level of the chiasmatic basal cistern. (C) Diffusion-weighted imaging sequences four days after surgery show circumscribed signal hyperintensity in the left uncal region indicative of local ischemic injury. Note the close anatomic proximity to the distal prechiasmatic course of the left optic nerve. (D) Corresponding hyperintensity in T2-weighted images indicates edema of the left temporomesial lobe that is consecutive to hypoperfusion and residual to preceding uncal herniation.