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- 出血,(特に)大量出血 / 多量に出血する
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出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2016/04/08 21:58:22」(JST)
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Duret haemorrhages are small lineal areas of bleeding in the midbrain and upper pons of the brainstem. They are caused by a traumatic downward displacement of the brainstem.[1]
It is named for Henri Duret.[2]
Contents
- 1 Pathogenesis
- 2 Causes
- 3 Diagnosis
- 4 Prognosis
- 5 Pathophysiology
- 6 References
- 7 External links
Pathogenesis
They are secondary to raised intracranial pressure with the formation of a transtentorial pressure cone involving the front part of the cerebral peduncles, the cerebral crura. Increased pressure above the tentorium may also involve other midbrain structures.
Kernohan's notch is a groove in the cerebral peduncle that may be caused by this displacement of the brainstem against the tentorial incisure. The resulting ipsilateral hemiparesis is a false localising sign,[3] known as the Kernohan-Woltman syndrome.[4] This may succeed or accompany temporal lobe (uncal) herniation and subfalcian herniation secondary to a supratentorial mass.
Causes
The common causes include hippocampal gyrus herniation through the tentorial notch, acute hematoma, edema following trauma, abscess, or tumor.
Imaging can be difficult.[5]
Diagnosis
Duret haemorrhages are demonstrated by medical imaging techniques of CT or MRI.
Prognosis
It usually indicates a fatal outcome.[6] However, survival has been reported.[7][8]
Pathophysiology
The mechanism is uncertain[9] but is probably caused by the displacement of the brainstem stretching and tearing perforating branches of the basilar artery to the pons; venous infarction may play a role.
References
- ^ Dorland's (2012). Dorland's Illustrated Medical Dictionary (32nd ed.). Elsevier. p. 824. ISBN 978-1-4160-6257-8.
- ^ Duret RL (April 1955). "[A rare and little known hemorrhagic syndrome.]". Brux Med (in French) 35 (16): 797–800. PMID 14378705.
- ^ Collier, J. The false localizing signs of intracranial tumour. Brain 27:490-508, 1904.
- ^ J. W. Kernohan JW, Woltman HW. Incisura of the crus due to contralateral brain tumor. Archives of Neurology and Psychiatry, Chicago, 1929, 21: 274–287.
- ^ Marupaka SK, Sood B (April 2008). "Atypical Duret haemorrhages seen on computed tomography". Emerg Med Australas 20 (2): 180–2. doi:10.1111/j.1742-6723.2008.01072.x. PMID 18377408.
- ^ Parizel PM, Makkat S, Jorens PG; et al. (January 2002). "Brainstem hemorrhage in descending transtentorial herniation (Duret hemorrhage)". Intensive Care Med 28 (1): 85–8. doi:10.1007/s00134-001-1160-y. PMID 11819006.
- ^ Fujimoto Y, Aguiar PH, Freitas AB, de Andrade AF, Marino Júnior R (October 2000). "Recovery from Duret hemorrhage: a rare complication after craniotomy--case report". Neurol. Med. Chir. (Tokyo) 40 (10): 508–10. doi:10.2176/nmc.40.508. PMID 11098635.
- ^ Kamijo Y, Soma K, Kishita R, Hamanaka S (November 2005). "Duret hemorrhage is not always suggestive of poor prognosis: a case of acute severe hyponatremia". Am J Emerg Med 23 (7): 908–10. doi:10.1016/j.ajem.2005.07.014. PMID 16291454.
- ^ Fisher CM (May 1995). "Brain herniation: a revision of classical concepts". Can J Neurol Sci 22 (2): 83–91. PMID 7627921.
External links
- Images of Duret Hemorrhage from MedPix
Cerebrovascular diseases (G45–G46 and I60–I69, 430–438)
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Brain ischemia/
cerebral infarction
(ischemic stroke/TIA) |
TACI, PACI |
- precerebral: Carotid artery stenosis
- cerebral: MCA
- ACA
- Amaurosis fugax
|
|
POCI |
- precerebral: Anterior spinal artery syndrome
- Vertebrobasilar insufficiency
- Subclavian steal syndrome
- brainstem: medulla
- Medial medullary syndrome
- Lateral medullary syndrome
- pons
- Medial pontine syndrome/Foville's
- Lateral pontine syndrome/Millard-Gubler
- midbrain
- Weber's
- Benedikt
- Claude's
- cerebral: PCA
- Lacunar stroke
- Dejerine–Roussy syndrome
|
|
General |
- cerebral: Cerebral venous sinus thrombosis
- CADASIL
- Binswanger's disease
- Transient global amnesia
|
|
|
Intracranial hemorrhage
(hemorrhagic stroke) |
Extra-axial |
- Epidural
- Subdural
- Subarachnoid
|
|
Cerebral/Intra-axial |
|
|
Brainstem |
|
|
|
Aneurysm |
- Cerebral aneurysm
- Intracranial berry aneurysm
- Charcot-Bouchard aneurysm
|
|
Other/general |
|
|
UpToDate Contents
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English Journal
- Reversible coma and Duret hemorrhage after intracranial hypotension from remote lumbar spine surgery: case report.
- Bonow RH1, Bales JW1, Morton RP1, Levitt MR1, Zhang F1.
- Journal of neurosurgery. Spine.J Neurosurg Spine.2016 Mar;24(3):389-93. doi: 10.3171/2015.6.SPINE1521. Epub 2015 Nov 20.
- Intracranial hypotension is a rare condition caused by spontaneous or iatrogenic CSF leaks that alter normal CSF dynamics. Symptoms range from mild headaches to transtentorial herniation, coma, and death. Duret hemorrhages have been reported to occur in some patients with this condition and are trad
- PMID 26588496
- Good outcomes in a patient with a Duret hemorrhage from an acute subdural hematoma.
- Nguyen HS1, Doan NB1, Gelsomino MJ1, Shabani S1, Mueller WM1.
- International medical case reports journal.Int Med Case Rep J.2016 Jan 27;9:15-8. doi: 10.2147/IMCRJ.S95809. eCollection 2016.
- BACKGROUND: Secondary brain stem injury is associated with transtentorial herniation, and manifests as "Duret" hemorrhages. Such an injury has been considered a terminal brain stem event with a high morbidity and mortality, sometimes discouraging continuation of care. However, there have been rare i
- PMID 26869816
- Duret haemorrhage with full recovery.
- Bermúdez G1, Areitio E.
- Acta neurochirurgica.Acta Neurochir (Wien).2015 Sep;157(8):1337-8; discussion 1338. doi: 10.1007/s00701-015-2486-5. Epub 2015 Jul 3.
- PMID 26136197
Japanese Journal
- 内頸動脈閉塞に伴う広範な脳梗塞に続発したDuret出血の1例
- 症例報告 CTによって確認したDuret出血の1例
- Recovery From Duret Hemorrhage: A Rare Complication After Graniotomy -Case Report-
Related Links
- 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. Pathology Raised supratentorial pressure causes the
- Duret hemorrhage, descending transtentorial herniation (脳卒中35: 227–231, 2013) はじめに 下行性テント切痕ヘルニアは,テント上占拠性病変 の拡大によって生じるが,脳幹を圧排することによ り,臨床的に意識障害の進行,脳幹 ...
- Duret hemorrhage: demonstration of ruptured paramedian pontine branches of the basilar artery on minimally invasive, whole body postmortem CT angiography Forensic Sci Med Pathol . 2012 Dec;8(4):436-40. doi: 10.1007/s12024-012-9329-y.
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