[Occlusion of a perforating artery, by descending tentorial herniation after head injury, supplying deep cerebral structure--report of 4 cases and their CT evaluation].

Four cases with descending tentorial herniation (DTH) after head injury which showed thalamic, mesencephalic and basal ganglionic low density areas (LDAs) manifesting a infarction in postoperative CT films are reported, and a possible mechanism are discussed in this paper. Case 1: Bilateral acute subdural hematoma with left DTH showed LDAs in the anterior part of the bilateral thalami, left occipital lobe and midbrain. The estimated occluded arteries included the anterior thalamoperforating artery(AThA), posterior cerebral artery and midbrain perforator. Case 2: Right acute epidural hematoma with DTH showed LDAs in the anterior part of the right thalamus and in the left globus pallidus. The estimated occluded arteries included the AThA and anterior choroidal artery. Case 3: Right acute epidural hematoma with DTH showed LDAs in the anterior part of the left thalamus, and in the left midbrain tegmentum. The estimated occluded artery was the interpeduncular thalamoperforating artery (IThA). Case 4: Right chronic subdural hematoma with DTH showed LDA mainly in the left thalamus except for the superior thalamic region. The estimated occluded arteries included the AThA and/or IThA and thalamogeniculate artery. Cases 1 and 4 were adult males and cases 2 and 3 were infant males, and the prognosis was good in the infant males, and poor in the adult males. Each of the 4 cases showed no loss of consciousness just after the head injury while 3 out of them deteriorated within several hours, and one was a case of chronic subdural hematoma.(ABSTRACT TRUNCATED AT 250 WORDS)