Pontine Hemorrhage after Surgical Evacuation of
Nontraumatic Subdural Hematoma

J Korean Neurol Assoc > Volume 17(6); 1999 > Article

Journal of the Korean Neurological Association 1999;17(6): 920-923.

비외상성 경막하혈종 제거 후 발생한 뇌교출혈

장지훈, 윤병우*박은미

서울대학교 의과대학 신경과학교실,서울대학교 의학연구원 신경과학연구소*

Pontine Hemorrhage after Surgical Evacuation of Nontraumatic Subdural Hematoma

Ji-Hoon Jang, M.D., Byung-Woo Yoon, M.D. * , Eun-Mi Park, M.D.

Department of Neurology, College of Medicine, Seoul National University, Neuroscience Research Institute, SNUMRC *

Abstract

Duret hemorrhage is characterized by an upper brainstem hemorrhage due to increased intracranial pressure by mass effect such as subdural hematoma or a brain tumor. The anteroposterior elongation and downward displacement of the upper brainstem by transtentorial herniation results in the compression and tearing of the paramedian perforating vessels that feed the upper brainstem tegmentum. The consequent hemorrhage that involves the upper brainstem renders recovery to be almost impossible. Following a tricuspid valve replacement surgery, a 56-year-old woman developed a left fronto-temporo-parietal nontraumatic subdural hematoma resulting in transtentorial herniation of the left mesial temporal lobe. A successful surgical evacuation of the hematoma was done with clinical improvement. Two days later, she was referred to neurology with an aggravated right side weakness, dysarthria, and a newly developed extraocular movement disturbance. A brain CT and MRI showed a pontine hemorrhage. We report a case of pontine hemorrhage, a Duret hemorrhage, after the surgical evacuation of nontraumatic subdural hematoma. J Korean Neurol Assoc 17(6):920~923, 1999 Key Words : Duret hemorrhage, Anticoagulation, Nontraumatic SDH, Transtentorial herniation, Pontine hemorrhage