Document Detail

Survival with good outcome after cerebral herniation and Duret hemorrhage caused by traumatic brain injury.
MedLine Citation:
PMID:  19012479     Owner:  NLM     Status:  MEDLINE    
Brainstem hemorrhage can occur as a primary or secondary event in traumatic brain injury (TBI). Secondary brainstem hemorrhage that evolves from raised intracranial pressure and transtentorial herniation is referred to as Duret hemorrhage. Duret hemorrhage following TBI has been considered an irreversible and terminal event. The authors report on the case of a young adult patient with TBI who presented with a low Glasgow Coma Scale score and advanced signs of cerebral herniation. She underwent an urgent decompressive hemicraniectomy for evacuation of an acute epidural hematoma and developed a Duret hemorrhage postoperatively. In accordance with the family's wishes, aggressive TBI monitoring and treatment in the intensive care unit was continued even though the anticipated outcome was poor. After a lengthy hospital course, the patient improved dramatically and was discharged ambulatory, with good cognitive functioning and a Glasgow Outcome Scale score of 4. Duret hemorrhage secondary to raised intracranial pressure is not always a terminal event, and by itself should not trigger a decision to withdraw care. Aggressive intracranial monitoring and treatment of a Duret hemorrhage arising secondary to cerebral herniation may enable a good recovery in selected patients after severe TBI.
Shirley I Stiver; Alisa D Gean; Geoffrey T Manley
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  110     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-02     Completed Date:  2009-07-29     Revised Date:  2010-01-21    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1242-6     Citation Subset:  AIM; IM    
Departments of Neurosurgery, University of California San Francisco, California, USA.
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MeSH Terms
Brain Stem Hemorrhage, Traumatic / complications*,  pathology,  surgery*
Decompression, Surgical
Encephalocele / etiology*,  pathology,  surgery*
Recovery of Function
Treatment Outcome
Comment In:
J Neurosurg. 2010 Jan;112(1):212; author reply 212-3   [PMID:  20043725 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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