Duret hemorrhage is not always suggestive of poor prognosis: a case of acute severe hyponatremia

Kamijo, Yoshito; Soma, Kazui; Kishita, Reiko; Hamanaka, Satoko

doi:10.1016/j.ajem.2005.07.014

Cited by 14 publications

(15 citation statements)

References 7 publications

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“…Indeed, a nontraumatic etiology, usually consistent with paradoxical herniation after lumbar puncture or rapid correction of hyponatremia, is extremely rare. 13,16,18 Good neurological outcome after Duret hemorrhages is seldom reported in adults and is usually related to timely evacuation of the mass lesion that determines DTH. Recently the contribution of brain plasticity has been also invoked to explain the good recovery of 2 pediatric cases with traumatic brain injury.…”

Section: Discussionmentioning

confidence: 99%

“…5,11,14 More rarely, DTH has been described in the absence of mass lesion as a complication of rapid correction of hyponatremia, with subsequent swollen brain parenchyma, or lumbar CSF drainage in the presence of open skull. 13,16,18 If the supratentorial pressure is not promptly relieved, the evolution of this condition may lead to acute sufferance (i.e., distortion and compression) of the brainstem, which is associated with a dismal prognosis. 8,17 We report the management of a case of trapped fourth ventricle complicated by DTH, in the absence of increased pressure or mass lesion in the supratentorial compartment.…”

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confidence: 99%

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Descending transtentorial herniation, a rare complication of the treatment of trapped fourth ventricle: case report

Frassanito

Markogiannakis

Bonaventura

et al. 2015

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Descending transtentorial herniation (DTH) is a complication of raised pressure in the supratentorial compartment, usually resulting from mass lesion of several etiologies. The authors report an exceptional case of DTH complicating the implant of a CSF shunting device in the trapped fourth ventricle of a 17-year-old boy in whom a second CSF shunting device had been implanted for neonatal posthemorrhagic and postinfectious hydrocephalus. The insidious clinical and radiological presentation of DTH, mimicking a malfunction of the supratentorial shunt, is documented. Ultimately, the treatment consisted of removal of the infratentorial shunt and endoscopic acqueductoplasty with stenting. The absence of supratentorial mass lesion and other described etiologies of DTH prompted the authors to speculate on the hydrodynamic pathogenesis of DTH in the present case.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Descending transtentorial herniation, a rare complication of the treatment of trapped fourth ventricle: case report

Frassanito

Markogiannakis

Bonaventura

et al. 2015

PED

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“…One case report discusses a brainstem hemorrhage after electrolyte disturbances in an adult, whereas 4 papers report on adults with brainstem hemorrhages after evacuation of mass lesions who had good neurological recovery. 4,8,10,12,13 The time to evacuation of the mass lesion in the aforementioned cases is unknown. However there is a growing number of patients with these "fatal" brainstem lesions who have good outcomes; therefore there has to be a commonality that allows a certain subset of patients to do well after significant brainstem compromise.…”

Section: Discussionmentioning

confidence: 99%

Pediatric brainstem hemorrhages after traumatic brain injury

Beier

Dirks

2014

PED

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Traumatic brain injuries afflict a large number of pediatric patients. The most severe injuries lead to increased intracranial pressure and herniation, with resultant changes in the brainstem. Traumatic brainstem hemorrhages have previously been associated with poor neurological outcome and fatality. However, this report discusses 2 pediatric patients who sustained severe head trauma with subsequent brainstem hemorrhages, and yet experienced good neurological outcome; the possible mechanism is described.

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“…Brainstem trauma with shear injury, hemorrhages (referred to as Duret hemorrhages) or contusion, can lead to RAS dysfunction as well. 9 Posterior fossa masses (typically cerebellar) adjacent to the brainstem may exert compressive effects and result in RAS dysfunction. Although less common, infiltrating tumors, demyelinating lesions, or infection (encephalitis) may lead to RAS dysfunction through various mechanisms.…”

Section: Brainstem and Diencephalic Injurymentioning

confidence: 99%