What are Duret hemorrhage?
Duret hemorrhage is a small hemorrhage (or multiple hemorrhages) seen in the medulla or pons of patients who are rapidly developing brain herniation, especially central herniation.
Where is Duret hemorrhage?
The hemorrhages named after Duret (also called secondary brainstem hemorrhage) occur in the brainstem following cerebral edema with herniation. These are thought to be due to the rupture of small penetrating vessels, particularly into the central portions of the midbrain, pons, and medulla.
What is a pontine haemorrhage?
Pontine haemorrhage, a form of intracranial haemorrhage, is most commonly due to long standing poorly-controlled chronic hypertension. It carries a very poor prognosis.
Why pinpoint pupils in pontine haemorrhage?
Pinpoint pupils due to pontine hemorrhages may result from sympathetic pathway lesions and irritation of parasympathetic pathways. In patients in a coma related to toxic-metabolic changes, in general the pupils are isochoric and reactive to light, except in the terminal stage.
What is a uncal herniation?
Uncal herniation occurs when rising intracranial pressure causes portions of the brain to move from one intracranial compartment to another. It is a life-threatening neurological emergency and indicates the failure of all adaptive mechanisms for intracranial compliance.
What is the survival rate of a pontine hemorrhage?
Primary pontine hemorrhage (PPH) accounts for approximately 5%–10% of intracranial hemorrhages, and the overall mortality rates in recent studies were 40%–50%.
Can you recover from pontine hemorrhage?
Pontine Stroke Recovery Time Typically, if the stroke was small, you can recover within about 6 months.
What part of the brain is the Intraparenchymal?
A parenchymal hemorrhage, or an intraparenchymal hemorrhage (IPH), is a bleed that occurs within the brain parenchyma, the functional tissue in the brain consisting of neurons and glial cells.
What does an uncus do?
Functionally, the uncus is involved in olfaction, emotions, and forming new memories mainly due to its connectivity with multiple nuclei and cortices related to these functions. Uncal herniation syndrome and uncinate fits of mesiotemporal epilepsy are the main neurological abnormalities associated with this structure.
Is uncal herniation reversible?
Uncal herniation can is reversible if recognized early and treated aggressively.
What is the prognosis of a Duret hemorrhage?
Duret haemorrhages can be demonstrated by medical imaging techniques of CT or MRI though difficult. Duret haemorrhages usually indicate a fatal outcome. However, survival has been reported. George Gershwin died after emergency surgery of a large brain tumour, believed to have been a glioblastoma.
Why is it called a Duret hemorrhage?
They are named after Henri Duret . Duret haemorrhages are named after Henri Duret ., who discovered these brainstem lesions in dogs with increased intracranial pressure. They are small linear areas of bleeding in the midbrain and upper pons of the brainstem.
What is the pathophysiology of Duret syndrome?
The hemorrhages named after Duret (also called secondary brainstem hemorrhage) occur in the brainstem following cerebral edema with herniation. These are thought to be due to the rupture of small penetrating vessels, particularly into the central portions of the midbrain, pons, and medulla.
What is the pathophysiology of diabetic insipidus (Duret’s hemorrhage)?
Duret’s haemorrhages occur within the brainstem due to shearing of the perforators, and traction damages the pituitary stalk causing diabetes insipidus. Eugene C. Lai MD, PhD, in Neurology Secrets (Fifth Edition), 2010