A Duret hemorrhage refers to small, punctate hemorrhages in the brainstem and pons seen on CT imaging, which are usually secondary and occur in the context of trauma.
Historical background
These brainstem hemorrhages were initially demonstrated by Henri Duret in dogs with increased intracranial pressure, and he was responsible for the eponym1.
Pathophysiology
From a pathophysiological perspective, a distinction must be made between a primary brainstem hemorrhage and a secondary hemorrhage, such as a Duret hemorrhage, which most likely occurs as a result of transtentorial herniation toward the brainstem2.
Localization
Duret hemorrhages typically occur in the midline, paramedian, and ventral regions of the tegmentum, upper pons, and mesencephalon3. If such hemorrhages are already visible on the initial CT after trauma, they are considered prognostically unfavorable for the subsequent course; according to individual case reports, rare cases of functionally good recovery have also been described4.
Imaging
References