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Subdural hematoma, uncal herniation and Duret brainstem hemorrhage

Case contributed by Andrew Dixon
Diagnosis certain

Presentation

Fall with loss of consciousness.

Patient Data

Age: 70 years
Gender: Male

This case featured in our 2016 Trauma Radiology Course which is now available to view online.

Large left sided acute subdural hematoma (predominantly over the cerebral convexity but with some extension over the falx and tentorium) producing marked midline shift to the right, left uncal herniation with compression of the brainstem resulting in a midline Duret hemorrhage within the pons. Trace right frontal and clival / prepontine subdural hematoma is also evident. 

Case Discussion

Large left sided acute subdural hematoma (predominantly over the cerebral convexity but with some extension over the falx and tentorium) producing marked midline shift to the right, left uncal herniation with compression of the brainstem resulting in an ominous Duret hemorrhage within the pons. The patient was palliated. 

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