Presentation
GCS 3. Found on floor.
Patient Data
Age: 85 years
Gender: Male
{"current_user":null,"step_through_annotations":true,"access":{"can_edit":false,"can_download":true,"can_toggle_annotations":true,"can_feature":false,"can_examine_pipeline_reports":false,"can_pin":false},"extraPropsURL":"/studies/118992/annotated_viewer_json?iframe=true\u0026lang=us"}
- large right subdural hematoma causes extensive intracranial mass effect with leftward subfalcine herniation and transtentorial herniation. No tonsillar herniation
- further parenchymal hemorrhage centered within the pons with intraventricular extension of this hemorrhage into the 4th ventricle
From the case:
Duret hemorrhage with large subdural hematoma
{"current_user":null,"step_through_annotations":true,"access":{"can_edit":false,"can_download":true,"can_toggle_annotations":true,"can_feature":false,"can_examine_pipeline_reports":false,"can_pin":false},"extraPropsURL":"/studies/118993/annotated_viewer_json?iframe=true\u0026lang=us"}
- the circle of Willis vessels are distorted on account of the large subdural hematoma
- there is reduced flow within the right posterior cerebral artery relative to the left, likely on account of the transtentorial herniation
Case Discussion
This case demonstrates a Duret hemorrhage secondary to rapid transtentorial herniation in the setting of a large right subdural hematoma (SDH).
It also illustrates the distortion and mass effect on the circle of Willis vessels evidenced by reduced flow in the ipsilateral right PCA.