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J Korean Neurosurg Soc. 2013 Jun;53(6):380-2. doi: 10.3340/jkns.2013.53.6.380. Epub 2013 Jun 30.

Precedence of Parenchymal Enhancement on CT Angiography to a Fatal Duret Hemorrhage.

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  • 1Department of Neurosurgery, Jeju National University College of Medicine, Jeju, Korea.


We report a case of fatal duret hemorrhage (DH) in a patient with acute tentorial subdural hematoma and bilateral chronic subdural hematoma along the cerebral hemispheres. Preoperative CT angiography (CTA) revealed prominent parenchymal enhancement in the ventral pontomesencephalic area. After burr-hole drainage, a large hemorrhage developed in this area. The parenchymal enhancement in the CTA may reflect the pontomensencephalic perforating vessel injury, and may be a sign of impending DH of acute transtentorial downward herniation. Previous use of aspirin and warfarin might have potentiated the process of DH and increase the extent of the bleed.


CT; Duret hemorrhage

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