Presentation
GCS 3. Found on floor.
Patient Data
Age: 85 years
Gender: Male
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- large right subdural haematoma causes extensive intracranial mass effect with leftward subfalcine herniation and transtentorial herniation. No tonsillar herniation
- further parenchymal haemorrhage centred within the pons with intraventricular extension of this haemorrhage into the 4th ventricle
From the case:
Duret haemorrhage with large subdural haematoma
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- the circle of Willis vessels are distorted on account of the large subdural haematoma
- 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 haemorrhage secondary to rapid transtentorial herniation in the setting of a large right subdural haematoma (SDH).
It also illustrates the distortion and mass effect on the circle of Willis vessels evidenced by reduced flow in the ipsilateral right PCA.
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