This axial (cross-sectional) CT image of the brain in a hypertensive patient shows a large intracerebral hemorrhage (bleed) in the right temporal lobe with decompression/extension of the hemorrhage into the ventricular system. There is severe mass effect with brain herniation. The downward trans tentorial herniation results in tearing of perforating arteries arising from the basilar artery resulting in secondary brainstem hemorrhage (Duret Hemorrhage) seen in the central part of this image.