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Duret hemorrhage

Dr Yuranga Weerakkody ◉ and A.Prof Frank Gaillard ◉ ◈ et al.

Duret hemorrhage is a small hemorrhage (or multiple hemorrhages) seen in the medulla or pons of patients who are rapidly herniating.

On this page:

Article:

Pathology
Radiographic features
Treatment and prognosis
Differential diagnosis
History and etymology
Related articles
References

Images:

Cases and figures

Pathology

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. 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 hemorrhage is one located in the midline near the pontomesencephalic junction. Often however, these hemorrhages can be multiple or even extend into the cerebellar peduncles.

Treatment and prognosis

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

Differential diagnosis

On imaging consider

primary hypertensive brainstem hemorrhage
- 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

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

Quiz questions

References

Stroke and intracranial haemorrhage

stroke and intracranial hemorrhage
- ischemic stroke
  - general discussions
  - scoring and classification systems
  - signs
    - hyperdense MCA sign
    - MCA dot sign
  - by region
    - hemispheric infarcts
      - frontal lobe infarct
      - parietal lobe infarct
        Gerstmann syndrome
      - temporal lobe infarct
      - occipital lobe infarct
        
        alexia without agraphia syndrome: PCA
        
        cortical blindness syndrome (Anton syndrome): top of basilar or bilateral PCA
        
        Balint syndrome: bilateral PCA
      - internal capsule infarct
        ataxic hemiparesis syndrome: MCA perforators or basilar artery perforators
    - lacunar infarct
      - lacunar stroke syndromes
    - thalamic infarct
      - Déjerine-Roussy syndrome (thalamic pain syndrome): thalamoperforators of PCA
      - top of the basilar syndrome
    - striatocapsular infarct
    - cerebellar infarct
    - brainstem infarct
      - midbrain infarct
        
        Benedikt syndrome: PCA
        
        Claude syndrome: PCA
        
        Nothnagel syndrome: PCA
        
        Weber syndrome: PCA
      - pontine infarct
        
        Brissaud-Sicard syndrome
        
        facial colliculus syndrome
        
        Gasperini syndrome: basilar artery or AICA
        
        inferior medial pontine syndrome (Foville syndrome): basilar artery
        
        lateral pontine syndrome (Marie-Foix syndrome): basilar artery or AICA
        
        locked-in syndrome: basilar artery
        
        Millard-Gubler syndrome: basilar artery
        
        Raymond syndrome: basilar artery
      - medullary infarct
        
        Babinski-Nageotte syndrome
        
        hemimedullary syndrome (Reinhold syndrome)
        
        lateral medullary stroke syndrome (Wallenberg syndrome)
        
        medial medullary syndrome (Déjerine syndrome)
    - acute spinal cord ischemia syndrome
  - by vascular territory
  - treatment options
    - mechanical thrombectomy
  - complications
    - crossed cerebellar diaschisis
    - hemorrhagic transformation of an ischemic infarct
      - cerebral intraparenchymal hyperattenuations post thrombectomy
- intracranial hemorrhage
  - intra-axial hemorrhage
    - signs
      - CTA spot sign
    - by region or type
  - extra-axial hemorrhage

Article information

rID: 7898

System: Central Nervous System

Tag: brainstem

Synonyms or Alternate Spellings:

Duret's haemorrhage
Duret's hemorrhage
Duret hemorrhage

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