Brainstem hemorrhage in descending transtentorial herniation (Duret hemorrhage)

Parizel, Paul M.; Makkat, Smitha; Jorens, Philippe G.; Özsarlak, Özkan; Cras, Patrick; Van Goethem, Johan W.; van den Hauwe, Luc; Verlooy, Jan; De Schepper, Arthur M.
January 2002
Intensive Care Medicine;Jan2002, Vol. 28 Issue 1, p85
Academic Journal
Objectives: To review clinical and radiological findings in patients with Duret hemorrhages and to discuss the pathophysiology and differential diagnosis of these lesions. Patients and methods: We reviewed the case records of four patients with Duret hemorrhages who had been admitted to the neurological intensive care unit with supratentorial mass lesions. Results: Descending transtentorial and subfalcine herniations were present in all cases. Three patients were admitted with acute subdural hematoma and one with intraparenchymal hemorrhage. Computed tomography revealed the presence of blood in the mesencephalon and upper pons. Three patients died; one survived with severe disabilities. Discussion: Duret hemorrhages are typically located in the ventral and paramedian aspects of the upper brainstem (mesencephalon and pons). The pathophysiology of Duret hemorrhage remains under debate: arterial origin (stretching and laceration of pontine perforating branches of the basilar artery), versus venous origin (thrombosis and venous infarction). Multifactorial causation seems likely. Conclusion: Duret hemorrhages are delayed, secondary brainstem hemorrhages. They occur in craniocerebral trauma victims with rapidly evolving descending transtentorial herniation. Diagnosis is made on computed tomography of the brain. In most cases the outcome is fatal. On the basis of our observations we believe that arterial hypertension and advanced age are risk factors for the development of Duret hemorrhage.


Related Articles

  • Surgical intensive care unit-the trauma surgery perspective. Kleber, Christian; Schaser, Klaus Dieter; Haas, Norbert P. // Langenbeck's Archives of Surgery;Apr2011, Vol. 396 Issue 4, p429 

    Purpose: This review addresses and summarizes the key issues and unique specific intensive care treatment of adult patients from the trauma surgery perspective. Materials and methods: The cornerstones of successful surgical intensive care management are fluid resuscitation, transfusion protocol...

  • Sodium and potassium in essential hypertension. Lever, A.F.; Beretta-Piccoli, C.; Brown, J.J.; Davies, D.L.; Fraser, R.; Robertson, J.I.S. // British Medical Journal (Clinical Research Edition);8/15/1981, Vol. 283 Issue 6289, p463 

    Examines the arterial pressure and body content of electrolytes in patients with essential hypertension. Enumeration of hypotheses proposed to explain the mechanisms related to electrolytes and arterial pressure; Development of renal lesions as a consequence of the hypertension;...

  • Changes in the gastric enteric nervous system and muscle: A case report on two patients with diabetic gastroparesis. Pasricha, Pankaj J.; Pehlivanov, Nonko D.; Gomez, Guillermo; Vittal, Harsha; Lurken, Matthew S.; Farrugia, Gianrico // BMC Gastroenterology;2008, Vol. 8, Special section p1 

    Background: The pathophysiological basis of diabetic gastroparesis is poorly understood, in large part due to the almost complete lack of data on neuropathological and molecular changes in the stomachs of patients. Experimental models indicate various lesions affecting the vagus, muscle, enteric...

  • Hemorragia subaracnoidea: epidemiología, etiología, fisiopatología y diagnóstico. Luis Rodríguez García, Pedro; Rodríguez García, Damaris // Revista Cubana de Neurología y Neurocirugía;2011, Vol. 1 Issue 1, p59 

    Objective: A literature review was carried out of more relevant and refined elements about Subarachnoid hemorrhage (SAH) epidemiology, etiology, physiopathology and diagnosis. Development: SAH is a diagnostic challenge and includes complex, sophisticated, multidisciplinary, and rarely routinely...

  • Assessment of hepatosplanchnic pathophysiology during thoracoabdominal aortic aneurysm repair using visceral perfusion and shunt Kunihara, Takashi; Shiiya, Norihiko; Wakasa, Satoru; Matsuzaki, Kenji; Matsui, Yoshiro // European Journal of Cardio-Thoracic Surgery;Apr2009, Vol. 35 Issue 4, p677 

    Abstract: Objective: Despite the recognition of importance to avoid visceral ischemia during thoracoabdominal aortic aneurysm (TAAA) repair, the methodology of visceral perfusion seems still controversial and its pathophysiology has not been clearly understood. We investigated hepatosplanchnic...

  • Value of delayed PET imaging in mucinous adenocarcinoma rectum: Should this be employed while evaluating mucinous tumors with FDG-PET? Basu, S.; Baghel, N. S. // Indian Journal of Cancer;Jul-Sep2011, Vol. 48 Issue 3, p374 

    The article discusses a case of a 15-year old male patient with bleeding per rectum and was detected to have concentric wall thickening. It states that the patient was diagnosed with mucinous carcinoma of the recturm and was refereed for flourodeoxyglucose positron emission tomography (FDG-PET)....

  • Percutaneous computed tomography-guided lung biopsy of solitary nodular ground-glass opacity. Zheng Yi-Feng; Jiang Li-Ming; Mao Wei-Min; Han Zhi-Qiang // Journal of Cancer Research & Therapeutics;2015 Supplement, Vol. 11, pC231 

    Objective: To evaluate the diagnostic performance and safety of percutaneous lung biopsy under computed tomography (CT)-fluoroscopic guidance for ground-glass opacity (GGO) lesions. Materials and Methods: Thirty-eight patients received core biopsy utilizing an automated cutting needle and were...

  • Critical care dysmotility: abnormal foregut motor function in the ICU/ITU patient. Quigley, E. M. M. // Gut;Oct2005, Vol. 54 Issue 10, p1351 

    Focuses on intensive care medicine. Opinion that while aspiration and feeding difficulties are well known challenges in the intensive care unit, their pathophysiology has been poorly understood; Suggestion that critically ill are subject to profound alterations in motor and sensory function of...

  • Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients. Hunziker, Sabina; Celi, Leo A.; Joon Lee; Howell, Michael D. // Critical Care;2012, Vol. 16 Issue 3, p1 

    Introduction: Recently, red cell distribution width (RDW), a measure of erythrocyte size variability, has been shown to be a prognostic marker in critical illness. The aim of this study was to investigate whether adding RDW has the potential to improve the prognostic performance of the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics