Brainstem hemorrhage in descending transtentorial herniation (Duret hemorrhage)

Abstract

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.

Subarachnoid Hemorrhage in Perivascular Spaces Mimicking Brainstem Hematoma

“…This association is extremely rare 6,7 and in our case seems unlikely, taking into account the location and pattern of the bleeding. Duret hemorrhage, another differential diagnosis was excluded due to the absence of signs of raised intracranial pressure and transtentorial herniation 8 . Our hypothesis for the apparent brainstem hematoma is that the SAH extended into existing perivascular spaces, eventually dissecting cranio-caudally along fibre tracts within the brainstem.…”

Descending transtentorial herniation, a rare complication of the treatment of trapped fourth ventricle: case report

“…2 This results in secondary brainstem hemorrhages with a peculiar distribution in the rostral midbrain and in the ventral portion of the pons, presenting in a delayed fashion, that are termed Duret hemorrhages. 1,8,17 The pathogenesis of Duret hemorrhages has been hypothesized to consist of 2 mechanisms, stretching and disruption of small central perforating arteries or compression of small rostral draining veins, both ensuing from the abrupt descent of the brainstem against the basilar artery, which is relatively immobilized by the circle of Willis. 23 In the present case, the posthemorrhagic and postinfectious etiology of the hydrocephalus may have contributed to the arachnoidal scarring and relative immobilization of the basilar artery.…”

“…13,16,18 If the supratentorial pressure is not promptly relieved, the evolution of this condition may lead to acute sufferance (i.e., distortion and compression) of the brainstem, which is associated with a dismal prognosis. 8,17 We report the management of a case of trapped fourth ventricle complicated by DTH, in the absence of increased pressure or mass lesion in the supratentorial compartment. Indeed, DTH resulted from a negative pressure gradient between the fourth ventricle and the supratentorial compartment.…”

Brain Stem Hemorrhage Following Burr Hole Drainage for Chronic Subdural Hematoma -Case Report-

“…3,9,15) The left-sided decompression was performed with short time lag before the right side procedure, which under such conditions might have led to transient aggravation of the right-sided transtentorial herniation by shifting and displacing the brain stem. Consequently, the vessels surrounding the brain stem may have torn, precipitating the hemorrhage into the brain stem.…”