Good outcomes in a patient with a Duret hemorrhage from an acute subdural hematoma. Int Med Case Rep J 2016;9:15-8
Date
02/13/2016Pubmed ID
26869816Pubmed Central ID
PMC4734784DOI
10.2147/IMCRJ.S95809Scopus ID
2-s2.0-84957555731 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
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 instances where patients have had reasonable recovery. We report another case, emphasizing that such an injury by itself should not deter aggressive measures, as good outcomes remain a possibility.
CASE PRESENTATION: A 37-year-old male sustained a right subdural hematoma after a mechanical fall while intoxicated. He presented initially with a Glasgow Coma Scale 15. Three days later, he exhibited acute neurological deterioration to Glasgow Coma Scale 4, requiring intubation and mannitol. Repeat scan demonstrated enlarging right subdural hematoma with worsening shift; brain stem hemorrhage was noted at pontomesencephalic junction. Patient was immediately taken for subdural hematoma evacuation. The following day, patient was able to sluggishly follow commands in all four extremities. He had a short stay for inpatient rehabilitation and underwent autologous cranioplasty at 3 months. On examination, he was awake, alert, and oriented to self, time, and location; he exhibited dysarthric speech, right ptosis, but followed commands in all four extremities with no focal motor weakness.
CONCLUSION: In contrast to the common belief, patients suffering from a "Duret" hemorrhage can still have a good outcome. "Duret" hemorrhages may not represent a fatal injury. The finding from this paper suggests the finding of "Duret" hemorrhages on imaging should not deter aggressive measures especially in patients with lesions causing significant mass effects. Overall clinical status should drive surgical options and clinical course.
Author List
Nguyen HS, Doan NB, Gelsomino MJ, Shabani S, Mueller WMAuthors
Wade M. Mueller MD Professor in the Neurosurgery department at Medical College of WisconsinSaman Shabani MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin
