Duret Hemorrhages

Excerpt

Duret hemorrhages are small, linear, or flame-shaped brainstem hemorrhages that occur due to transtentorial herniation involving the midbrain and upper pons. First described by the French neurologist Henri Duret, these hemorrhages result from vascular compromise due to downward displacement of the brainstem that leads to stretching and tearing of perforating arteries, particularly the paramedian branches of the basilar artery. Brainstem hemorrhages are broadly classified as primary or secondary. Primary hemorrhages arise from direct trauma, hypertension, or coagulopathy, compared to secondary hemorrhages, such as Duret hemorrhages, that occur due to descending transtentorial herniation from various etiologies.

Studies on brain trauma by Duret localized autonomic disturbances to the brainstem and linked them to microhemorrhages in the pons and medulla. While historically considered a postmortem finding, advances in neuroimaging have enabled antemortem diagnosis of these hemorrhages, highlighting the importance of their early recognition in those who are critically ill. Given their association with devastating neurological injury, Duret hemorrhages signify an urgent need for aggressive management of intracranial hypertension and herniation syndromes. This course analyzes the pathophysiology, imaging characteristics, clinical implications, and management strategies associated with Duret hemorrhages.