title: Precedence of Parenchymal Enhancement on CT Angiography to a Fatal Duret Hemorrhage.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Jeju National University College of Medicine, Jeju, Korea.
authors.forename: Ki-Bum
authors.initials: KB
authors.lastname: Sim
authors.forename: Dong Gyu
authors.initials: DG
authors.lastname: Na
authors.forename: Ji Kang
authors.initials: JK
authors.lastname: Park
keywords: CT; Duret hemorrhage