Duret haemorrhage
3979018
223837402
2008-07-06T02:04:06Z
Arcadian
104523
/* Causes */ wik
[[Image:Gray768.png|thumb|Brainstem]]
'''Duret haemorrhages''' (also spelled, ''Duret hemorrhages'') are small areas of bleeding in the [[Anatomical terms of location|ventral and paramedian]] parts of the upper [[brain stem|brainstem]], ([[midbrain]] and [[pons]]). <ref name="urlDorlands Medical Dictionary:Duret hemorrhages">{{cite web |url=http://www.mercksource.com/pp/us/cns/cns_hl_dorlands_split.jsp?pg=/ppdocs/us/common/dorlands/dorland/nine/10024444.htm |title=Dorlands Medical Dictionary:Duret hemorrhages |format= |work= |accessdate=}}</ref>
It is named for [[RL Duret]].<ref name="pmid14378705">{{cite journal |author=Duret RL |title=[A rare and little known hemorrhagic syndrome.] |language=French |journal=Brux Med |volume=35 |issue=16 |pages=797–800 |year=1955 |month=April |pmid=14378705 |doi= |url=}}</ref>
==Causes==
They are secondary to raised [[intracranial pressure]] with formation of a [[transtentorial]] pressure cone involving the cerebral peduncles ([[crus cerebri]]) and other midbrain structures caused by raised pressure above the [[tentorium cerebelli|tentorium]].
[[Kernohan’s notch]] is a groove in the [[cerebral peduncle]] that may be caused by this displacement of the [[brainstem]] against the incisura of the tentorium. The resulting ipsilateral [[hemiparesis]] is a false localising sign,<ref>Collier, J. The false localizing signs of intracranial tumour. ''Brain'' 27:490-508, 1904. </ref> known as the ''Kernohan-Woltman syndrome''.<ref>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. </ref> This may succeed or accompany temporal lobe (uncal) [[uncal herniation|herniation]] and subfalcian herniation secondary to a [[supratentorial]] mass.
==Causes==
The common causes are an acute [[haematoma]], [[oedema]] following [[Physical trauma|trauma]], [[abscess]], or [[tumour]].
Imaging can be difficult.<ref name="pmid18377408">{{cite journal |author=Marupaka SK, Sood B |title=Atypical Duret haemorrhages seen on computed tomography |journal=Emerg Med Australas |volume=20 |issue=2 |pages=180–2 |year=2008 |month=April |pmid=18377408 |doi=10.1111/j.1742-6723.2008.01072.x |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=1742-6731&date=2008&volume=20&issue=2&spage=180}}</ref>
==Diagnosis==
The Duret haemorrhage is demonstrated at [[Computed tomography|CT]] or [[Magnetic resonance imaging|MRI]].
==Prognosis==
It usually indicates a fatal outcome.<ref name="pmid11819006">{{cite journal |author=Parizel PM, Makkat S, Jorens PG, ''et al'' |title=Brainstem hemorrhage in descending transtentorial herniation (Duret hemorrhage) |journal=Intensive Care Med |volume=28 |issue=1 |pages=85–8 |year=2002 |month=January |pmid=11819006 |doi=10.1007/s00134-001-1160-y |url=http://dx.doi.org/10.1007/s00134-001-1160-y}}</ref> However, survival has been reported.<ref name="pmid11098635">{{cite journal |author=Fujimoto Y, Aguiar PH, Freitas AB, de Andrade AF, Marino Júnior R |title=Recovery from Duret hemorrhage: a rare complication after craniotomy--case report |journal=Neurol. Med. Chir. (Tokyo) |volume=40 |issue=10 |pages=508–10 |year=2000 |month=October |pmid=11098635 |doi= |url=http://joi.jlc.jst.go.jp/JST.JSTAGE/nmc/40.508?from=PubMed}}</ref><ref name="pmid16291454">{{cite journal |author=Kamijo Y, Soma K, Kishita R, Hamanaka S |title=Duret hemorrhage is not always suggestive of poor prognosis: a case of acute severe hyponatremia |journal=Am J Emerg Med |volume=23 |issue=7 |pages=908–10 |year=2005 |month=November |pmid=16291454 |doi=10.1016/j.ajem.2005.07.014 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-6757(05)00265-2}}</ref>
==Pathophysiology==
The mechanism is uncertain<ref name="pmid7627921">{{cite journal |author=Fisher CM |title=Brain herniation: a revision of classical concepts |journal=Can J Neurol Sci |volume=22 |issue=2 |pages=83–91 |year=1995 |month=May |pmid=7627921 |doi= |url=}}</ref> but is probably caused by the displacement of the [[brainstem]] stretching and [[laceration|lacerating]] [[pontine]] perforating branches of the [[basilar artery]]; venous [[infarction]] may play a role.
==References==
{{reflist|2}}
{{disease-stub}}
[[Category:Diseases]]
[[pl:Krwotok Dureta]]
==External links==
* [http://rad.usuhs.edu/medpix/medpix.html?mode=image_finder&action=search&srchstr=Duret%20hemorrhage&srch_type=all#top Images of Duret Hemorrhage] from MedPix