Duret haemorrhages

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Duret haemorrhages
Illustration of the brainstem
Synonyms	Brainstem haemorrhages
Pronounce	N/A
Specialty	N/A
Symptoms	Coma, abnormal posturing, pupillary abnormalities
Complications	Brain herniation, death
Onset	Acute
Duration	Variable
Types	N/A
Causes	Traumatic brain injury, intracranial hypertension
Risks	Severe head trauma, cerebral edema
Diagnosis	CT scan, MRI
Differential diagnosis	Pontine haemorrhage, subarachnoid haemorrhage
Prevention	N/A
Treatment	Supportive care, management of intracranial pressure
Medication	N/A
Prognosis	Poor
Frequency	Rare
Deaths	N/A

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.

See also

• Brain herniation
• Intracranial pressure
• Traumatic brain injury
• Henri Duret