Sudden loss of consciousness and coma. The patient is hypertensive.
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Large right temporal intracerebral acute haematoma with right basal ganglionic extension and subependymal haemorrahge of the ipsilateral lateral ventricle. Associated marked mass effect is noted in form of uncal herniation with compression of the brain stem against the contralateral tentorial edge.
The midbrain and pons show large parenchymal hemorrhage which extends to the 4th ventricular cavity.
The large right temporal and basal ganglionic hypertensive haematoma causes uncal herniation and damage to the perforating branches of the basilar artery and consequently brainstem parenchymal hemorrhage (Duret hemorrhage) which is fatal and of bad prognosis.