Duret haemorrhages: Difference between revisions

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'''Duret haemorrhages''' are small areas of bleeding in the midbrain and upper pons of the brainstem. They are secondary to raised intracranial pressure with formation of a transtentorial pressure cone involving the cerebral peduncles (crus cerebri) and other midbrain structures caused by a downward displacement of the brainstem.
== Duret Hemorrhages ==


== Causes ==
[[File:Duret_haemorrhages_Gray768.png|thumb|right|Illustration of Duret hemorrhages]]
Duret haemorrhages are caused by [[brain herniation]], specifically transtentorial (uncal) herniation, where the brain is displaced downwards towards the foramen magnum. This displacement stretches and compresses blood vessels, leading to haemorrhage. The most common cause of this displacement is a [[subdural haematoma]] or [[epidural haematoma]], usually secondary to head trauma.


== Symptoms ==
'''Duret hemorrhages''' are small linear areas of bleeding in the midbrain and upper pons of the brainstem. These hemorrhages are typically associated with [[traumatic brain injury]] and are considered a secondary brainstem injury. They are named after the French neurologist [[Henri Duret]], who first described them.
The symptoms of Duret haemorrhages are related to the areas of the brain that are affected. These can include:
 
* [[Coma]]
== Pathophysiology ==
* [[Decerebrate posturing]]
 
* [[Pupillary abnormalities]]
Duret hemorrhages occur due to the downward displacement of the brainstem, often as a result of increased [[intracranial pressure]] and [[brain herniation]]. The most common type of herniation associated with Duret hemorrhages is [[transtentorial herniation]], where the [[temporal lobe]] is pushed downwards through the [[tentorial notch]]. This displacement causes stretching and tearing of the small penetrating arteries that supply the brainstem, leading to hemorrhage.
* [[Respiratory abnormalities]]
 
== Clinical Significance ==
 
The presence of Duret hemorrhages is a grave prognostic sign, often indicating severe brain injury and poor outcome. They are typically seen in the context of severe [[head trauma]] or [[intracerebral hemorrhage]] that leads to significant brain swelling and herniation.


== Diagnosis ==
== Diagnosis ==
Diagnosis of Duret haemorrhages is typically made by [[Computed tomography|CT]] or [[Magnetic resonance imaging|MRI]] of the brain. These imaging studies can show the characteristic small areas of bleeding in the midbrain and upper pons.
 
Duret hemorrhages can be identified using [[neuroimaging]] techniques such as [[CT scan]] or [[MRI]]. On imaging, they appear as small, linear areas of hyperdensity (on CT) or hyperintensity (on MRI) in the midbrain and pons.


== Treatment ==
== Treatment ==
Treatment of Duret haemorrhages is focused on reducing the raised intracranial pressure that caused the haemorrhage. This can involve:
* [[Surgery]] to remove the cause of the raised pressure, such as a subdural or epidural haematoma.
* Medications to reduce swelling in the brain.
* Supportive care, such as [[ventilation]] to support breathing.


== Prognosis ==
There is no specific treatment for Duret hemorrhages themselves. Management focuses on addressing the underlying cause of increased intracranial pressure and preventing further brain herniation. This may involve surgical interventions such as [[decompressive craniectomy]] or medical management to reduce brain swelling.
The prognosis for Duret haemorrhages is generally poor, as they are often associated with severe brain injury and significant neurological impairment.
 
== Related Pages ==


== See also ==
* [[Brain herniation]]
* [[Brain herniation]]
* [[Subdural haematoma]]
* [[Intracranial pressure]]
* [[Epidural haematoma]]
* [[Traumatic brain injury]]
 
* [[Henri Duret]]
[[Category:Neurological disorders]]
[[Category:Medical emergencies]]
[[Category:Brain diseases]]


{{stub}}
[[Category:Neurology]]
[[Category:Neurosurgery]]

Revision as of 10:46, 15 February 2025

Duret Hemorrhages

File:Duret haemorrhages Gray768.png
Illustration of Duret hemorrhages

Duret hemorrhages are small linear areas of bleeding in the midbrain and upper pons of the brainstem. These hemorrhages are typically associated with traumatic brain injury and are considered a secondary brainstem injury. They are named after the French neurologist Henri Duret, who first described them.

Pathophysiology

Duret hemorrhages occur due to the downward displacement of the brainstem, often as a result of increased intracranial pressure and brain herniation. The most common type of herniation associated with Duret hemorrhages is transtentorial herniation, where the temporal lobe is pushed downwards through the tentorial notch. This displacement causes stretching and tearing of the small penetrating arteries that supply the brainstem, leading to hemorrhage.

Clinical Significance

The presence of Duret hemorrhages is a grave prognostic sign, often indicating severe brain injury and poor outcome. They are typically seen in the context of severe head trauma or intracerebral hemorrhage that leads to significant brain swelling and herniation.

Diagnosis

Duret hemorrhages can be identified using neuroimaging techniques such as CT scan or MRI. On imaging, they appear as small, linear areas of hyperdensity (on CT) or hyperintensity (on MRI) in the midbrain and pons.

Treatment

There is no specific treatment for Duret hemorrhages themselves. Management focuses on addressing the underlying cause of increased intracranial pressure and preventing further brain herniation. This may involve surgical interventions such as decompressive craniectomy or medical management to reduce brain swelling.

Related Pages