Duret hemorrhage

Discussion:

Toxic brain edema associated with cerebral infarction can be severe that it obliterates the basal cisterns and forces the brain to herniate through the tentorial notch (uncal herniation) and below the falx cerebri (subfalcine herniation). As a sequelae there is downward displacement of the brain stem which can lead to damage to the perforators of the basilar artery that supplies the brain stem and may progress to brain stem coning within the foramen magnum leading to death. This patient requires urgent craniectomy.

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