Large extradural haematoma complicated by Duret haemorrhage and ischaemic stroke
Presentation
Found obtunded. No further history available.
Patient Data
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.
Immediate post-op
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.