Fig. 4

Case 2: 55 years old female patient came to the Emergency department with acute onset left side body weakness, confused, the initial CT brain A revealed right acute ischemic stroke with lower trunk right MCA as well as small ACA territory distribution without midline shift, admitted under observation, on the 2nd day of her admission her GCS dropped to GCS 11, with unequal pupils an urgent CT brain B revealed evolutional change at the infarction core with midline shift of about 12 mm, underwent emergency surgical decompressive craniectomy and duroplasty that was performed within 2 h from the time of deterioration and the patient was sent to ICU, on the 2nd postoperative day he GCS 8t, FU CT brain was done (C, D, F) and revealed satisfactory decompression. After extubation her GCS was 11. FU CT brain revealed lax brain at two weeks PO (E), after two weeks patient developed left LL swelling and Doppler US revealed DVT, IVC filter G was inserted and started on anticoagulants, unfortunate she developed massive pulmonary embolism and passed away 18 days postoperatively