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Intraparenchymal hemorrhage with subfalcine uncal and transtentorial herniation

Case contributed by Euan Zhang
Diagnosis almost certain

Presentation

Follow-up after spontaneous intracranial hemorrhage.

Patient Data

Age: 60 years
Gender: Male

There is partial resolution of the right frontotemporal intraparenchymal hematoma. There is a moderate degree of surrounding vasogenic edema which is exerting local mass effect causing a midline shift, right uncal herniation, and right transtentorial herniation.

Decompressive craniotomy has resulted in improvement of mass effect and resultant herniations.

Comparison of pre- & post-decompressive craniotomy

Comparison of pre- and post-decompressive craniotomy shows the appearance of subfalcine and uncal hernations relative to their normal anatomy.

Case Discussion

Pay attention to follow-up examinations, which can show worsened vasogenic edema surrounding intraparenchymal hematomas.

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