The enigma of traumatic, behaviourally benign brain stem bleeds: Case report

Mathai, K. I.; Jain, Amita; Singh, Dharmveer; Dutta, Sgs; Sengupta, Shamik; Harikrishnan, Venkatesh

doi:10.1016/s0973-0508(09)80009-9

Cited by 4 publications

(5 citation statements)

References 9 publications

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“…4 There is a predisposition for involvement in median rostral pons and ventral tegmentum of the midbrain in secondary brainstem hemorrhage. 8 Differentiation between primary and secondary brain stem hemorrhage may be challenging, since Duret hemorrhages may occur within half an hour of the initial trauma. 4 In our case, the brainstem hemorrhage was considered secondary, as it was not present on the initial CT scan, and the postoperative CT scan showed bleed in the midline and ventral aspect of the brainstem.…”

Section: Discussionmentioning

confidence: 99%

Duret Hemorrhage after Extradural Hematoma Evacuation–A Rare Entity

Tyngkan

Mahfouz

Bilal

et al. 2021

Indian Journal of Neurotrauma

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Traumatic brainstem injury can be classified as primary or secondary. Secondary brainstem hemorrhage that evolves from raised intracranial pressure (ICP) and transtentorial herniation is referred to as Duret hemorrhage. We report a 25-year-old male who underwent emergency craniotomy, with evacuation of acute epidural hematoma, and postoperatively developed fatal Duret hemorrhage. Duret hemorrhage after acute epidural hematoma (EDH) evacuation is a very rare complication and the outcome is grave in most of the cases.

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Section: Discussionmentioning

confidence: 99%

Duret Hemorrhage after Extradural Hematoma Evacuation–A Rare Entity

Tyngkan

Mahfouz

Bilal

et al. 2021

Indian Journal of Neurotrauma

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“…Traumatic brain stem hemorrhages may be grouped based on primary or secondary etiologies. 12 Primary etiologies are commonly associated with the traumatic event, accompanied by diffuse supratentorial lesions, and frequently identified on initial imaging. Mechanisms include diffuse axonal injury from acceleration/deceleration, inertial injury at the midbrain due to the tentorium or clivus, and hyperextension of the cervical spine that contuses the lower brain stem.…”

Section: Discussionmentioning

confidence: 99%

“…Mechanisms include diffuse axonal injury from acceleration/deceleration, inertial injury at the midbrain due to the tentorium or clivus, and hyperextension of the cervical spine that contuses the lower brain stem. 2 , 12 …”

Section: Discussionmentioning

confidence: 99%

“… 2 , 8 , 10 , 11 Ishizaka et al 1 suggested that the overall, primary parenchymal injury may have a more significant influence on prognosis than Duret hemorrhages, where patients with Duret hemorrhages but relatively less primary injury may be salvageable. 1 , 12 In addition, Beier and Dirks 2 believed that a younger age (with inherent plasticity) could also be a factor for favorable prognosis.…”

Section: Discussionmentioning

confidence: 99%

“… 2 – 6 However, there have been rare instances where patients have had reasonable recovery. 1 , 2 , 7 – 12 We report another case, emphasizing that such an injury by itself should not deter aggressive measures, as good outcomes remain a real possibility.…”

Section: Introductionmentioning

confidence: 92%

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Good outcomes in a patient with a Duret hemorrhage from an acute subdural hematoma

Nguyen¹,

Doan²,

Gelsomino³

et al. 2016

IMCRJ

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BackgroundSecondary brain stem injury is associated with transtentorial herniation, and manifests as “Duret” hemorrhages. Such an injury has been considered a terminal brain stem event with a high morbidity and mortality, sometimes discouraging continuation of care. However, there have been rare instances where patients have had reasonable recovery. We report another case, emphasizing that such an injury by itself should not deter aggressive measures, as good outcomes remain a possibility.Case presentationA 37-year-old male sustained a right subdural hematoma after a mechanical fall while intoxicated. He presented initially with a Glasgow Coma Scale 15. Three days later, he exhibited acute neurological deterioration to Glasgow Coma Scale 4, requiring intubation and mannitol. Repeat scan demonstrated enlarging right subdural hematoma with worsening shift; brain stem hemorrhage was noted at pontomesencephalic junction. Patient was immediately taken for subdural hematoma evacuation. The following day, patient was able to sluggishly follow commands in all four extremities. He had a short stay for inpatient rehabilitation and underwent autologous cranioplasty at 3 months. On examination, he was awake, alert, and oriented to self, time, and location; he exhibited dysarthric speech, right ptosis, but followed commands in all four extremities with no focal motor weakness.ConclusionIn contrast to the common belief, patients suffering from a “Duret” hemorrhage can still have a good outcome. “Duret” hemorrhages may not represent a fatal injury. The finding from this paper suggests the finding of “Duret” hemorrhages on imaging should not deter aggressive measures especially in patients with lesions causing significant mass effects. Overall clinical status should drive surgical options and clinical course.

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Pathology of the Facial Nerve

Borges

2014

Temporal Bone Imaging

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The enigma of traumatic, behaviourally benign brain stem bleeds: Case report

Cited by 4 publications

References 9 publications

Duret Hemorrhage after Extradural Hematoma Evacuation–A Rare Entity

Duret Hemorrhage after Extradural Hematoma Evacuation–A Rare Entity

Good outcomes in a patient with a Duret hemorrhage from an acute subdural hematoma

Pathology of the Facial Nerve

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