title: Duret hemorrhage: demonstration of ruptured paramedian pontine branches of the basilar artery on minimally invasive, whole body postmortem CT angiography.
abstract: A 25 year old male died suddenly and unexpectedly. Postmortem CT scanning revealed marked raised intracranial pressure with brainstem compression due to subarachnoid, subdural and parenchymal hemorrhage. A hyperdense mass at the termination of the right internal carotid artery was thought to represent an aneurysm. Postmortem, whole body CT angiography failed to fill the aneurysm but did demonstrate multiple central pontine linear enhancing structures in continuity with the mid basilar artery and small foci of contrast leak into the adjacent mid pontine parenchyma. Autopsy confirmed subarachnoid hemorrhage, a thrombosed and ruptured proximal right middle cerebral artery aneurysm and Duret hemorrhages in the mid pons. This finding supports the theory that Duret hemorrhages occur as a result of perforating pontine branch of the basilar arterial rupture but does not exclude the contribution of venous congestion.
authors.affiliation: Victorian Institute of Forensic Medicine and Department of Forensic Medicine, Monash University, 57-83 Kavanagh St, Southbank, VIC, 3006, Australia.
authors.forename: Ka Lip
authors.initials: KL
authors.lastname: Chew
authors.forename: Yeliena
authors.initials: Y
authors.lastname: Baber
authors.forename: Linda
authors.initials: L
authors.lastname: Iles
authors.forename: Christopher
authors.initials: C
authors.lastname: O'Donnell
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000473:pathology; D001488:Basilar Artery / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media / Q000008:administration & dosage; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging; D049429:Forensic Pathology; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging* / Q000473:pathology; D019586:Intracranial Hypertension / Q000150:complications; D020767:Intracranial Thrombosis / Q000473:pathology; D008297:Male; D020768:Middle Cerebral Artery / Q000473:pathology; D011149:Pons / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging
chemical_list: D003287:Contrast Media