Fig. 3

a Coronal reformatted non-contrast CT brain image of a 34-year-old man who sustained a penetrating knife injury to the left zone 2 of the neck requiring emergency surgical neck exploration prior to imaging assessment because of catastrophic haemorrhage. Therefore, pre-treatment CT and MDCTA were not performed because of the clinically evident active life-threatening haemorrhage on arrival in the emergency department. The non-contrast CT brain assessment was performed immediately prior to the post-operative MDCTA (b) and demonstrates acute thromboembolic “malignant” left anterior circulation infarction: there is already ischaemic demarcation of both the left middle and anterior cerebral artery territories with severe subfalcine herniation and midline shift; hyperdense thromboembolus is evident in the left middle cerebral artery (arrows) and proximal left anterior cerebral artery. b Axial image of MDCTA of the same patient as in a performed immediately post-operatively following internal carotid artery repair reveals a tail of extensive intraluminal thrombus extending distally from the site of vessel injury and repair (arrow). c Axial non-contrast CT brain of the same patient as in a and b performed 48 h later. The patient has undergone interval emergency left decompressive hemicraniectomy: the left anterior circulation low attenuation infarction is more established and the significant mass effect, subfalcine herniation and intracranial pressure related to swollen oedematous parenchyma have been ameliorated by hemicraniectomy. Unfortunately, brain-stem death was confirmed 12 h later