Learning objectives
To review the pathogenesis of Duret hemorrhage.
To illustrate the radiographic features of Duret hemorrhage.
To emphasise the importance of imaging follow-up after traumatic brain injury.
Background
Traumatic brain injury can result in hemorrhage in midbrain and pons at the time of impact (primary) or in a later stage (secondary).
Secondary brainstem hemorrhage is called Duret hemorrhage.
Duret hemorrhage is caused by downward (transtentorial) cerebral herniation due to raised intracranial pressure from a rapidly expanding supratentorial mass lesion.
Duret hemorrhage has a high incidence of death and persistent vegetative outcome.
There are few case reports describing good outcome.
Arterial damage or venous congestion caused by sudden downward movement of the brainstem against...
Imaging findings OR Procedure details
Often there is an absence of brainstem injury on the initial CT-scan.
CT / MRI findings are:
- initial mass lesion
- secondary lesion i.e typical Duret localisation in midbrain and pons at and near the midline of the rostral pons and the ventral tegmentum of the midbrain.
- increased density consistent with blood in pons or midbrain,
- compression of prepontine cistern,
- anteroposterior elongation of the midbrain
- ischemic lesions due to herniation
Conclusion
In this educational exhibit,
we’ve discussed the pathogenesis and imaging findings of Duret hemorrhage after traumatic brain injury.
It is important for every radiologist to understand the bad prognosis associated with this often small pontine bleeding.
Personal Information
Patrick Dewachter,
MD
UZ Brussel - Department of Radiology
Laarbeeklaan 101
1090 Jette,
Brussels,
Belgium
pdewachter (at) gmail (dot) com
References
Parizel PM,
Makkat S,
Jorens PG,
et al.
Brainstem hemorrhage in
descending transtentorial herniation (Duret hemorrhage).
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Sood B: Atypical Duret haemorrhages seen on computed tomography.
Emerg Med Australas 20:180–182,
2008
Kamijo Y,
Soma K,
Kishita R,
Hamanaka S: Duret hemorrhage is not always suggestive of poor prognosis: a case of acute severe hyponatremia.
Am J Emerg Med 23:908–910,
2005
Stiver SI,
Gean AD,
Manley GT: Survival with good outcome after cerebral herniation and Duret hemorrhage caused by traumatic...