Callosomarginal infarction secondary to transfalcial herniation

To evaluate the prevalence of anterior cerebral artery infarcts in the context of transfalcial herniation, 1100 cerebral CT scans were reviewed. Three patients had acute intracranial hemorrhages resulting in transfalcial herniation and subsequent focal ipsilateral paracentral lobule or superior frontal gyrus infarcts. The infarcts are presumed to have resulted from compression and compromise of the terminal portions of the callosomarginal artery against the falx. Callosomarginal infarcts are reflective of severe, acute hemispheric insult. As such, they seem to portend a declining clinical condition, and thus may provide another CT indication of a poor clinical outcome.