Abstract
We herein report a case of an 89-year-old woman who developed secondary brain stem hemorrhage due to broad brain infarction. She suddenly presented with loss of consciousness and right hemiplegia. Head CT and MRI showed fresh broad brain infarction in the left cerebral hemisphere. On MRA, her left internal carotid artery was occluded. She had atrial fibrillation and was diagnosed with cardioembolic stroke. Glycerol was used to treat her cerebral edema. However, her congestive heart failure worsened on day 4 after stroke onset, and the dose of glycerol was reduced. On day 7 after admission, she was in a deep coma and showed decerebrate posturing and bilateral pathological reflexes. Head CT revealed brain stem hemorrhage and transtentorial herniation. Secondary brain stem hemorrhage due to progressive descending transtentorial herniation, so-called Duret hemorrhage, subsequently occurred. In general, Duret hemorrhage is known to be caused by elevated intracranial pressure, as occurs in rapid progressive herniation with head injury or in brain hemorrhage. The present case shows that Duret hemorrhage can occur in supratentorial broad brain infarction.
