Duret Hemorrhage: Etiology, Pathophysiology, Clinical Features, Imaging, Treatment, and Prognosis
Introduction Duret hemorrhage represents one of the most devastating complications of raised intracranial pressure (ICP) and brain herniation. First described by Henri Duret, this hemorrhage typically occurs in the brainstem, particularly the pons and midbrain, as a result of downward transtentorial herniation. Although relatively rare, it carries a high morbidity and mortality rate, making early recognition and management critical. In this column, we will explore the cause, etiology, pathophysiology, epidemiology, clinical presentation, imaging features, treatment, and prognosis of Duret hemorrhage, referencing the attached case study and figures. Case Background A 64-year-old man with a history of hypertension, alcohol use disorder, and prior right-sided subdural hematoma requiring surgical decompression was found unconscious at home after head trauma. Non-contrast CT scans revealed an acute left subdural hematoma with midline shift and signs of transtentorial herniati...