Atypical Duret haemorrhages seen on computed tomography

Area of Science:

• Neurology
• Neurosurgery
• Radiology

Background:

• Subdural hemorrhage can occur without significant trauma.
• Duret hemorrhages are secondary brain stem hemorrhages often associated with herniation.
• Imaging Duret hemorrhages is uncommon.

Observation:

• An 80-year-old male presented with a one-day history of headache.
• He was diagnosed with a gross subdural hemorrhage without a clear history of trauma.
• The hemorrhage led to descending transtentorial herniation and secondary Duret hemorrhages.

Findings:

• The case demonstrated a rare instance of Duret hemorrhages identified on imaging.
• The posterior location of the subdural bleed was unusual.
• Duret hemorrhages were confirmed as the cause of secondary brain stem hemorrhages.

Implications:

• This case underscores the importance of considering subdural hemorrhage in elderly patients with acute headaches, even without trauma.
• The presence of Duret hemorrhages indicates a poor prognosis and high mortality.
• Further research into the specific mechanisms and imaging characteristics of Duret hemorrhages is warranted.