Cerebral transtentorial herniation determinates the course of progressive focal supratentorial impairments and acute hemorrhagic hemispheric stroke. Clinical and pathomorphological comparisons were done in patients with acute hemorrhagic hemispheric stroke. The following predictors of hemorrhagic hemispheric stroke lethal outcome were verified: 1) acute onset of coma in association with oculomotor dysfunctions; 2) focal hemiplegia in association with peduncular hemiplegia and paratonic rigiditydue due to compression of ipsilateral peduncle; 3) quick addition of vital disorders due to hemorrhagies into tectorium and it’s necrobiosis; 4) lethal outcome caused by herniation into occipital foramen due to necrobiosis of neurons in caudal part of brain stem tectorium.
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