Duret haemorrhages

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.

Causes

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

The symptoms of Duret haemorrhages are related to the areas of the brain that are affected. These can include:

• Coma
• Decerebrate posturing
• Pupillary abnormalities
• Respiratory abnormalities

Diagnosis

Diagnosis of Duret haemorrhages is typically made by CT or MRI of the brain. These imaging studies can show the characteristic small areas of bleeding in the midbrain and upper pons.

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

The prognosis for Duret haemorrhages is generally poor, as they are often associated with severe brain injury and significant neurological impairment.

See also

• Brain herniation
• Subdural haematoma
• Epidural haematoma

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