Duret hemorrhages

Last revised by Frank Gaillard on 01 Nov 2022

Duret hemorrhages are small, usually multiple, hemorrhages in the midbrain or pons resulting from rapidly developing brain herniation, especially central herniation. They have a dismal prognosis.

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 midbrain or pons near the pontomesencephalic junction 5. 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

  • Figure 1: Duret hemorrhages
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  • Case 1
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  • Case 2
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  • Case 3
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  • Case 4
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  • Case 5
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  • Case 6
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  • Case 7
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  • Case 8: T1w hyperintense acute blood
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  • Case 9: Acute intracranial hemorrhage
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