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A Case of Brainstem Duret Hemorrhage Caused By Lobar Hemorrhagic Stroke

Article Information

Carmen Popa1*, Maria-Emilia Cerghedean-Florea2, Denisa Tanasescu3, Mihai Faur4,5, Andrei Moisin4,5

1Sibiu County Emergency Clinical Hospital, Department of Radiology and Medical Imaging.

2 Lucian Blaga University of Sibiu, Faculty of Medicine.

3Department of Nursing and Dentistry, ''Lucian Blaga'' University of Sibiu.

4Sibiu County Clinical Emergency Hospital, Department I of General Surgery.

5Lucian Blaga University of Sibiu, Faculty of Medicine, Department of Surgery.

*Corresponding Author:

Carmen Popa, Sibiu County Emergency Clinical Hospital, Department of Radiology and Medical Imaging.

Received: 24 February 2023; Accepted: 06 March 2023; Published: 16 March 2023

Citation: Carmen Popa, Maria-Emilia CerghedeanFlorea, Denisa Tanasescu, Mihai Faur, Andrei Moisin. A Case of Brainstem Duret Hemorrhage Caused By Lobar Hemorrhagic Stroke. Journal of Radiology and Clinical Imaging. 6 (2023): 48-49

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Abstract

This article is depicting the lobar hemorrhage with secondary subfalcine and transtentorial herniation as a cause of Duret hemorrhage on a computed-tomography scan

Image Article

Article Details

Introduction

Clinical Image

Stroke is the foremost cause of death and disability, with 7 million deaths worldwide, being the third leading cause of death after heart disease and cancer.[1,2] According to data literature available by now, intracerebral hemorrhages account for about 15% of all strokes, representing bleedings located in the brain parenchyma, with a complex physiopathology mechanism through the direct pressure effects of an acutely expanding mass.[1] Hematoma may lead to herniation, hydrocephalus and increased intracranial pressure.[3,4] Duret hemorrhage can result from any cause of descending transtentorial herniation, as a result of increased intracranial pressure, which causes intracranial compartmental shifts.[5] It is most commonly associated with increases in intracranial pressure caused by a variety of causes, including intraparenchymal hemorrhages, brain neoplasms and diffuse cerebral edema.[6,7] Most frequent involvement  are in the midline, paramedian, and ventral tegmentum of the upper pons and midbrain.[5,7] We present the case of a 70-year old male who is transfered at the emergency department in a comatous state. Non-contrast head computed-tomography examination reveals a voluminous acute hematic accumulation in the right cerebral hemisphere, located cortically and subcortically, lobar hemorrhage type, 10/6/4.5 cm in size (AP/LL/CC), with a volume of 140.4 cm3 (Figure 1).

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Figure 1:  Acute intraparenchymal haematoma involving the right cerebral hemisphere with ventricular extension

The collection shows panventricular effacement, with marked compressive effect on the right lateral ventricle,  2 cm left midline shift (Figure 2), with subfalcine herniation and  downwards transtentorial herniation (Figure 3) with compression on the midbrain where acute hematic petechiae are visible at the level of the tegmentum and the right paramedian tectal plate (Figure 4).

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Figure 2: Lobar haemorrhage with 2 cm left midline shift

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Figure 3: Subfalcine and downwards transtentorial herniation

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Figure 4: Tegmentum and the right paramedian tectal plate hematic petechiae

Associated with this there is significant accentuation of periventricular white matter hypodensity, right fronto-parietal and falx cerebri subarachnoid haemorrhage (Figure 5), hydrocephalus with transependymal and moderate diffuse supratentorial oedema.

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Figure 5: Right fronto-parietal and falx cerebri subarachnoid haemorrhage, transependymal and moderate diffuse supratentorial oedema

Conflicts of Interest:

The authors declare no competing interests.

References:

  1. Mendiola JMF-P de, Arboix A, García-Eroles L, Sánchez-López MJ. Acute Spontaneous Lobar Cerebral Hemorrhages Present a Different Clinical Profile and a More Severe Early Prognosis than Deep Subcortical Intracerebral Hemorrhages—A Hospital-Based Stroke Registry Study. Biomedicines [Internet]. 11 (1) (2023): 223.
  2. Bratu D, Boicean A, Tanasescu C, Sofariu C, Mihetiu A, et al. Textile Polypropylene Allografts and their Postoperative Tissue Reaction in the Surgery of Inguinal Hernia. Materiale Plastice. 54 (1) (2017): 119-121.
  3. Roth EJ. Lobar Hemorrhage. Encyclopedia of Clinical Neuropsychology [Internet]. (2011); 1472-1473.
  4. Pirvut MV, Grigore N, Mihai I, Priporeanu AT, Racheriu M, et al. Comparative Study Between Polydioxanone Unidirectional Barbed Suture and Absorbable Polyglactin Running Suture in Partial Nephrectomy. Materiale Plastice [Internet]. 2018 [cited 2023 Feb 24];
  5. Gogia B, Bhardwaj A. Duret Hemorrhages [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2022.
  6. Szakács J, Duica L-C, Racheriu M. Quality of Life and Negative Affectivity at the Patients with Stroke and Musculoskeletal Disorders. Balneo and PRM Research Journal. 12 (3) (2021): 275-279.
  7. Radu N, Roman V, Bostan M, Radu E, Tanasescu C. Influence of some spice food based bioproducts on human monocytic cells line type THP-1. Molecular Crystals and Liquid Crystals.655 (1) (2017): 114-123.

Journal Statistics

Impact Factor: * 3.7

CiteScore: 2.9

Acceptance Rate: 11.01%

Time to first decision: 10.4 days

Time from article received to acceptance: 2-3 weeks

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