Duret haemorrhage

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Brainstem

Duret hemorrhages are small areas of bleeding in the ventral and paramedian parts of the upper brainstem, (midbrain and pons).[1]

It is named for Henri Duret.[2]

Pathogenesis[edit]

They are secondary to raised intracranial pressure with formation of a transtentorial pressure cone involving the cerebral peduncles (crus cerebri) and other midbrain structures caused by raised pressure above the tentorium.

Kernohan’s notch is a groove in the cerebral peduncle that may be caused by this displacement of the brainstem against the incisura of the tentorium. The resulting ipsilateral hemiparesis is a false localising sign,[3] known as the Kernohan-Woltman syndrome.[4] This may succeed or accompany temporal lobe (uncal) herniation and subfalcian herniation secondary to a supratentorial mass.

Causes[edit]

The common causes include hippocampal gyrus herniation through the tentorial notch, acute hematoma, edema following trauma, abscess, or tumor.

Imaging can be difficult.[5]

Diagnosis[edit]

The Duret haemorrhage is demonstrated at CT or MRI.

Prognosis[edit]

It usually indicates a fatal outcome.[6] However, survival has been reported.[7][8]

Pathophysiology[edit]

The mechanism is uncertain[9] but is probably caused by the displacement of the brainstem stretching and lacerating pontine perforating branches of the basilar artery; venous infarction may play a role.

References[edit]

  1. ^ "Dorlands Medical Dictionary:Duret hemorrhages". 
  2. ^ Duret RL (April 1955). "[A rare and little known hemorrhagic syndrome.]". Brux Med (in French) 35 (16): 797–800. PMID 14378705. 
  3. ^ Collier, J. The false localizing signs of intracranial tumour. Brain 27:490-508, 1904.
  4. ^ J. W. Kernohan JW, Woltman HW. Incisura of the crus due to contralateral brain tumor. Archives of Neurology and Psychiatry, Chicago, 1929, 21: 274–287.
  5. ^ Marupaka SK, Sood B (April 2008). "Atypical Duret haemorrhages seen on computed tomography". Emerg Med Australas 20 (2): 180–2. doi:10.1111/j.1742-6723.2008.01072.x. PMID 18377408. 
  6. ^ Parizel PM, Makkat S, Jorens PG, et al. (January 2002). "Brainstem hemorrhage in descending transtentorial herniation (Duret hemorrhage)". Intensive Care Med 28 (1): 85–8. doi:10.1007/s00134-001-1160-y. PMID 11819006. 
  7. ^ Fujimoto Y, Aguiar PH, Freitas AB, de Andrade AF, Marino Júnior R (October 2000). "Recovery from Duret hemorrhage: a rare complication after craniotomy--case report" ([dead link]Scholar search). Neurol. Med. Chir. (Tokyo) 40 (10): 508–10. doi:10.2176/nmc.40.508. PMID 11098635. 
  8. ^ Kamijo Y, Soma K, Kishita R, Hamanaka S (November 2005). "Duret hemorrhage is not always suggestive of poor prognosis: a case of acute severe hyponatremia". Am J Emerg Med 23 (7): 908–10. doi:10.1016/j.ajem.2005.07.014. PMID 16291454. 
  9. ^ Fisher CM (May 1995). "Brain herniation: a revision of classical concepts". Can J Neurol Sci 22 (2): 83–91. PMID 7627921. 

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