Posterior cerebral artery territory infarct due to subdural hematoma and uncal herniation
Presentation
Found GCS 4.
Patient Data
There is a 6mm left convexity acute subdural hematoma with extension along the tentorium cerebelli and falx. Evidence of raised intracranial pressure, with diffuse loss of hemispheric sulci bilaterally, compression of the left lateral and third ventricles, 5mm rightward midline shift and obliteration of the basal cisterns with transtentorial herniation and compression of the midbrain. There is loss of grey-white matter differentiation within the left occipital and temporal lobes, consistent with acute infarction of the left posterior cerebral artery (PCA).
Conclusion:
Acute left subdural hematoma with evidence of severely raised intracranial pressure and acute left PCA territory infarct.
Case Discussion
Great case for the signs of raised ICP and the complication of PCA infarct, where the PCA is compressed by uncal herniation across the tent.
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