title: Brainstem hemorrhage in descending transtentorial herniation (Duret hemorrhage).
abstract: OBJECTIVE
  To review clinical and radiological findings in patients with Duret hemorrhages and to discuss the pathophysiology and differential diagnosis of these lesions.
  
  
  METHODS
  We reviewed the case records of four patients with Duret hemorrhages who had been admitted to the neurological intensive care unit with supratentorial mass lesions.
  
  
  RESULTS
  Descending transtentorial and subfalcine herniations were present in all cases. Three patients were admitted with acute subdural hematoma and one with intraparenchymal hemorrhage. Computed tomography revealed the presence of blood in the mesencephalon and upper pons. Three patients died; one survived with severe disabilities.
  
  
  CONCLUSIONS
  Duret hemorrhages are typically located in the ventral and paramedian aspects of the upper brainstem (mesencephalon and pons). The pathophysiology of Duret hemorrhage remains under debate: arterial origin (stretching and laceration of pontine perforating branches of the basilar artery), versus venous origin (thrombosis and venous infarction). Multifactorial causation seems likely.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium. parizelp@uia.ua.ac.be
authors.forename: Paul M
authors.initials: PM
authors.lastname: Parizel
authors.forename: Smitha
authors.initials: S
authors.lastname: Makkat
authors.forename: Philippe G
authors.initials: PG
authors.lastname: Jorens
authors.forename: Ozkan
authors.initials: O
authors.lastname: Ozsarlak
authors.forename: Patrick
authors.initials: P
authors.lastname: Cras
authors.forename: Johan W
authors.initials: JW
authors.lastname: Van Goethem
authors.forename: Luc
authors.initials: L
authors.lastname: van den Hauwe
authors.forename: Jan
authors.initials: J
authors.lastname: Verlooy
authors.forename: Arthur M
authors.initials: AM
authors.lastname: De Schepper
mesh_terms: D000368:Aged; D020203:Brain Stem Hemorrhage, Traumatic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014057:Tomography, X-Ray Computed