Duret haemorrhages
Template:Infobox medical condition (new) Duret haemorrhages are small linear areas of bleeding in the midbrain and upper pons of the brainstem. They are caused by a traumatic downward displacement of the brainstem.[1]
They are named after Henri Duret.
Causes
Duret haemorrhages are named after Henri Duret,[2] who discovered these brainstem lesions in dogs with increased intracranial pressure.[3] They are small linear areas of bleeding in the midbrain and upper pons of the brainstem.Script error: No such module "Unsubst".
They are caused by a traumatic downward displacement of the brainstem with parahippocampal gyrus herniation through the tentorial notch.[4] or acute hematoma, edema following trauma, abscess, or tumor.Script error: No such module "Unsubst".
Pathogenesis
Duret haemorrhages are haemorrhages secondary to raised intracranial pressure with formation of a transtentorial pressure cone involving the front part of the cerebral peduncles, the cerebral crura. Increased pressure above the tentorium may also involve other midbrain structures.Script error: No such module "Unsubst".
Kernohan's notch is a groove in the cerebral peduncle which may be caused by this displacement of the brainstem against the tentorial incisure. The resulting ipsilateral hemiparesis is a false localising sign,[5] known as the Kernohan-Woltman syndrome.[6] This may succeed or accompany temporal lobe (uncal) herniation and subfalcian herniation secondary to a supratentorial mass.Script error: No such module "Unsubst".
The pathophysiological mechanism is uncertain[7] but is probably caused by the displacement of the brainstem stretching and tearing perforating branches of the basilar artery to the pons; venous infarction may play a role.Script error: No such module "Unsubst".
Diagnosis
Duret haemorrhages can be demonstrated by medical imaging techniques of CT or MRI though difficult.[8]
Prognosis
Duret haemorrhages usually indicate a fatal outcome.[9] However, survival has been reported.[10][11]
Society and culture
George Gershwin died after emergency surgery of a large brain tumour, believed to have been a glioblastoma. The fact that he had suddenly collapsed and become comatose when he stood up on his last day of life, has been interpreted as brain herniation and Duret haemorrhages.[12]
References
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- ↑ Duret haemorrhage - Neurosurgical lexicon
- ↑ Script error: No such module "citation/CS1".
- ↑ Collier, J. The false localizing signs of intracranial tumour. Brain 27:490-508, 1904.
- ↑ J. W. Kernohan JW, Woltman HW. Incisura of the crus due to contralateral brain tumor. Archives of Neurology and Psychiatry, Chicago, 1929, 21: 274–287.
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- ↑ Takahiro Mezaki, Gershwin's death and Duret haemorrhage NEJM, 12 August 2017
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External links
- Images of Duret Hemorrhage from MedPix
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