Large extradural hematoma complicated by Duret hemorrhage and ischemic stroke
Presentation
Found obtunded. No further history available.
Patient Data
Large left parietal extradural hematoma. Left temporal parenchymal hematoma. Small hyperdensity in the pons consistent with a Duret hemorrhage. Massive rightward midline shift with subfalcine, uncal and descending transtentorial herniation. Left parietal scalp hematoma.
Immediate post-op
Left craniotomy with evacuation of the large extradural hematoma.
Pontine (Duret) hemorrhage is better seen. Pontine and right midbrain hypoattenuation suspicious for ischemic change. Acute left ACA/MCA/PCA territory infarcts. Left temporal parenchymal hematoma again noted.
ICP monitor and subdural drain.
Case Discussion
With massive midline shift ischemic strokes can develop due to compression of the cerebral arteries. Duret hemorrhages are another complication, again due to pressure effects on the perforating arterial and/or venous branches.