Figure 2.

Example case illustrating delayed cerebral infarction adjacent to blood on the cerebral convexity that was associated with a cluster of SDs and angiographic vasospasm. (A) Representative CT image of the initial scan at the skull base. The initial scan was performed on Day 1 after the initial haemorrhage. Linear hyperdense abnormalities were observed in the sulci of the left cerebral convexity consistent with SAH that extensively covered the cortical surface (10.6 ml). Note that the anterior portion of the left superior temporal sulcus was also filled with blood (arrow). Furthermore, the left MCA aneurysm was surrounded by a hyperdense mass at the left temporal pole consistent with perianeurysmal haematoma that extended into cerebral parenchyma (11.8 ml). Only small to moderate amounts of blood were found in the Sylvian fissure (5.5 ml), the basal cisterns (4.5 ml), the interhemispheric fissure (1.2 ml) and in the ventricles (1.1 ml). (B) Representative FLAIR image of Image_late on Day 9 at the skull base. A new hyperintense signal was observed in the anterior portion of the superior temporal sulcus (arrow). The corresponding area showed hyperintensity on diffusion-weighted images and hypointensity on the apparent diffusion coefficient (ADC) map. These findings suggested a new delayed infarct in the temporal MCA territory adjacent to the sulcal blood clot seen on the initial CT scan (arrow). (C) The left angiogram on Day 9 revealed severe vasospasm in the intracranial segment of the internal carotid artery, the A1, M1 and M2 segments (see arrowheads for left MCA vasospasm). (D) The 3D visualization depicts the spatial relationship between the delayed MCA infarct (green label) and the electrode strip (electrodes 1–6). The strip was located on the left frontolateral cortex, whereas the delayed infarct evolved in the left temporal cortex. The shortest distance was measured between the infarct boundary and electrode 6. It amounted to 28 mm.