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Duret haemorrhage

Duret haemorrhage is a small haemorrhage (or multiple haemorrhages) seen in the medulla or pons of patients who are rapidly herniating

Pathophysiology

Supratentorial haemorrhage causes the brainstem and mesial temporal lobes to be forced downwards through the tentorial hiatus. As a result of this shift it is believed that perforating branches from the basilar artery and/or draining veins are damaged with resultant parenchymal haemorrhage. Usually it is seen in patients with severe herniation for 12-24 hours prior to death 2.

Radiographic features

The classical appearance of a duret haemorrhage is one located in the midline near the pontomesencephalic junction. Often however, these haemorrhages can be multiple or even extend into the cerebellar peduncles.

Differential diagnosis

  • primary hypertensive brain stem haemorrhage
    • usually larger
    • mid pons
    • absence of herniation initially (although hydrocephalus may well develop)
  • brainstem contusion/diffuse axonal injury
    • dorsal midbrain (tectum and periaqueductal grey matter)
    • usually multifocal and smaller

History and etymology

Described by R L Duret in 1955 4.


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