Duret hemorrhage

Last revised by Dr Calum Worsley on 11 Oct 2021

Duret hemorrhage is a small hemorrhage (or multiple hemorrhages) seen in the medulla or pons of patients who are rapidly developing brain herniation, especially central herniation

Raised supratentorial pressure 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 hemorrhage. Most commonly it is seen in patients with severe herniation 12 to 24 hours prior to death 2.

The classical appearance of a Duret hemorrhage is a single small, round hemorrhage located in the midline of the medulla or pons near the pontomesencephalic junction. Often, however, these hemorrhages can be multiple or even extend into the cerebellar peduncles.

Usually considered fatal in the majority of cases although occasional cases have been reported to have favorable outcomes 6.

On imaging consider

It was first described by Henri Duret (1849-1921), a French surgeon, in 1874 4,7.

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Cases and figures

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  • Case 8: T1w hyperintense acute blood
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  • Case 9: Acute intracranial hemorrhage
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