Acute traumatic midbrain hemorrhage: experimental and clinical observations with CT.

Abstract

Traumatic brain stem hemorrhage (TBH) after blunt head impact is an uncommon injury and has historically been associated with high mortality. Retrospective clinical review identified 64 patients with TBH admitted during a 5-year period. Complete imaging and clinical records for 45 of these patients demonstrated that TBH could be categorized into three groups. The most frequent site of hemorrhage, in 31 (69%) of 45 patients (group 1), was the midline rostral anterior brain stem, posterior to the interpeduncular cistern, and this injury was associated with a 71% survival rate. This pattern was also associated with a predominantly anterior site of head and/or face impact. Eight (18%) patients (group 2) had miscellaneous foci of acute brain stem hemorrhage with seven (88%) surviving. Six (13%) patients (group 3) had brain stem hemorrhage associated with transtentorial herniation and brain stem compression, with 100% mortality. Experimental findings in a canine model and clinical results indicate that the anterior rostral midbrain is a common site of TBH and appears to arise from sudden craniocaudal displacement of the brain at impact. Survival is unexpected high with this location of traumatic midbrain hemorrhage.

Dramatic recovery after severe descending transtentorial herniation-induced Duret haemorrhage: A case report and review of literature

“…Duret haemorrhage is a secondary brainstem haemorrhage that usually occurs at the mid-line in the pons or midbrain as a result of descending transtentorial herniation [10,11]. Previous reports have hypothesized that Duret haemorrhage are caused by the stretching and disruption of perforating branches of the basilar artery as a result of caudal brainstem movement, with venous infarction and reperfusion injuries following surgical decompression as other possible causes [8].…”

Traumatic basilar pseudoaneurysm with a basilar-cavernous arteriovenous fistula

“…A possible mechanism in our case is suggested by the presence of anterior brain-stem lesions on CT and MRI at the time of trauma. This primary brain-stem injury probably results from shearing of the perforating vessels relative to the less mobile basilar artery [19]. More extreme shearing may lead to basilar artery laceration, extensive subarachnoid haemorrhage and the formation of a pseudoaneurysm.…”

Trauma Radiology: Part IV. Imaging of Acute Craniocerebral Trauma

“…Prim a n brainstem lesion develop froni direct impact of the brainstem against the tentorium, leading to lateral contusions, shearing of the brainstem, dorsolateral contusions, lateral displacement of the brainstem from herniation compressing the cerebral peduncle into the tentoriuni (Kernohans's notch) [18], sudden caudal displacement of the brainstem producing a~ulsion of anterior penetrating brainstem arteries, and anterior midline hemorrhage (Fig 17) [18], or direct contusion resulting froni lon~occipital impacts. Hemorrhagic lesions, usually seen in the upper pons, result from herniation (Duret hemorrhage), and they carry a uniformly poor prognosis.…”