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Sudden onset of unresponsiveness. GCS 3. History of arterial hypertension.
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Large left basal intracerebral acute hematoma with left lateral ventricular extension. 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.
Duret's hemorrhage is caused by rupture of the cerebral perforating arteries, due to their distension in case of cerebral herniation.