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Intracranial Hemorrhage (ICH)
Published in Swati Goyal, Neuroradiology, 2020
Various types of cerebral herniation include: Subfalcine herniation (cingulate herniation): Displacement of brain tissue under the cerebral falx. It results in compression of the ipsilateral ventricle, dilatation of the contralateral ventricle and shifting of the ipsilateral ACA and the subependymal veins across the midline.Uncal herniation (downward transtentorial herniation): Medial part of the temporal lobe is pushed down toward the cerebellum. It results in effacement of the ipsilateral suprasellar cistern, basal cisterns, and enlargement of the ipsilateral cerebellopontine angle cistern, along with the inferomedial displacement of the anterior choroidal, PCom, and posterior cerebral arteries in severe cases. It may also result in midbrain hemorrhage (Duret hemorrhage).Ascending transtentorial herniation: Less common; upward herniation of vermis and cerebellar hemispheres through the tentorial incisura.Transalar (transsphenoidal) herniation.Tonsillar herniation: Downward displacement and herniation of the cerebellar tonsils at the level of the foramen magnum.
Unilateral chronic subdural hematoma due to spontaneous intracranial hypotension: a report of four cases
Published in British Journal of Neurosurgery, 2020
Yoshinari Osada, Ichiyo Shibahara, Atsuhiro Nakagawa, Hiroyuki Sakata, Kuniyasu Niizuma, Ryuta Saito, Masayuki Kanamori, Miki Fujimura, Shinsuke Suzuki, Teiji Tominaga
A 51-year-old male (Table 1 and Figure 1) with a history of hypertension and diabetes was suspected of having SIH. However, a detailed radiological examination was not performed. One morning, he was found in a stuporous state and subsequently became comatose with anisocoria and decerebrate rigidity at midnight. Head CT revealed the following: left CSDH, transtentorial herniation, basal cistern obliteration, and Duret hemorrhage (Figure 1(A)). Emergency burr-hole evacuation was performed; however, no improvement was noted in his consciousness. Based on the patient’s history of orthostatic headache revealed by his family, underlying SIH was suspected. At midnight, emergency blind epidural blood patch (EBP) with a mixture of contrast agent at Th1 and Th12 (the technique named sandwich blind EBP) was performed to cover the spine as much as possible. Subsequent sagittal spine CT demonstrated a high-density area along the epidural space between Th3 and Th10 (Figure 1(B)). Cerebral diffusion-weighted imaging revealed infarction of the right thalamus, pons, and bilateral occipital cortices (Figure 1(C)). Axial brain gadolinium-enhanced T1-weighted (T1Gd) MRI revealed pachymeningeal enhancement (Figure 1(D)), which was consistent with underlying SIH. The patient exhibited persistent disturbance of consciousness and was transferred to a rehabilitation hospital on day 17.
Duret hemorrhage complicating a sinking skin flap syndrome
Published in British Journal of Neurosurgery, 2019
Mickael Cardinale, Eric Meaudre, Pierre-Julien Cungi, Cédric Nguyen, Pierre Esnault, Christophe Joubert
Duret hemorrhage has always been reported during an episode of increased intracranial pressure with transtentorial herniation. It is primarily thought to be the result of central perforating arterial shearing by rapidly descending herniation against the relatively fixed basilar artery anchored to the clivus, although a venous origin has also been proposed.1,2 Regardless of the cause, Duret hemorrhages generally point to poor prognosis because the multiple descending pathways for control of voluntary movement as well as the structures responsible for maintaining arousal are severely damaged.