Document Detail

Brainstem hemorrhage in descending transtentorial herniation (Duret hemorrhage).
MedLine Citation:
PMID:  11819006     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To review clinical and radiological findings in patients with Duret hemorrhages and to discuss the pathophysiology and differential diagnosis of these lesions. PATIENTS AND METHODS: We reviewed the case records of four patients with Duret hemorrhages who had been admitted to the neurological intensive care unit with supratentorial mass lesions. RESULTS: Descending transtentorial and subfalcine herniations were present in all cases. Three patients were admitted with acute subdural hematoma and one with intraparenchymal hemorrhage. Computed tomography revealed the presence of blood in the mesencephalon and upper pons. Three patients died; one survived with severe disabilities. DISCUSSION: Duret hemorrhages are typically located in the ventral and paramedian aspects of the upper brainstem (mesencephalon and pons). The pathophysiology of Duret hemorrhage remains under debate: arterial origin (stretching and laceration of pontine perforating branches of the basilar artery), versus venous origin (thrombosis and venous infarction). Multifactorial causation seems likely. CONCLUSION: Duret hemorrhages are delayed, secondary brainstem hemorrhages. They occur in craniocerebral trauma victims with rapidly evolving descending transtentorial herniation. Diagnosis is made on computed tomography of the brain. In most cases the outcome is fatal. On the basis of our observations we believe that arterial hypertension and advanced age are risk factors for the development of Duret hemorrhage.
Paul M Parizel; Smitha Makkat; Philippe G Jorens; Ozkan Ozsarlak; Patrick Cras; Johan W Van Goethem; Luc van den Hauwe; Jan Verlooy; Arthur M De Schepper
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't     Date:  2001-11-29
Journal Detail:
Title:  Intensive care medicine     Volume:  28     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2002 Jan 
Date Detail:
Created Date:  2002-01-30     Completed Date:  2002-03-27     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  85-8     Citation Subset:  IM    
Department of Radiology, University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
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MeSH Terms
Brain Stem Hemorrhage, Traumatic / diagnosis,  mortality,  physiopathology*
Diagnosis, Differential
Hypertension / complications
Middle Aged
Risk Factors
Tomography, X-Ray Computed

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