Large extradural haematoma complicated by Duret haemorrhage and ischaemic stroke

Case contributed by Dr Henry Knipe

Presentation

Found obtunded. No further history available.

Patient Data

Age: 30 years
Gender: Male

Large left parietal extradural haematoma. Left temporal parenchymal haematoma. Small hyperdensity in the pons consistent with a Duret haemorrhage. Massive rightward midline shift with subfalcine, uncal and descending transtentorial herniation. Left parietal scalp haematoma. 

Left craniotomy with evacuation of the large extradural haematoma. 

Pontine (Duret) haemorrhage is better seen. Pontine and right midbrain hypoattenuation suspicious for ischaemic change. Acute left ACA/MCA/PCA territory infarcts. Left temporal parenchymal haematoma again noted. 

ICP monitor and subdural drain. 

Case Discussion

With massive midline shift ischaemic strokes can develop due to compression of the cerebral arteries. Duret haemorrhages are another complication, again due to pressure effects on the perforating arterial and/or venous branches. 

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Case Information

rID: 48915
Case created: 31st Oct 2016
Last edited: 16th Feb 2017
Inclusion in quiz mode: Included

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