Duret brainstem hemorrhage: chronological illustration and favorable outcome in a young trauma patient.

BACKGROUND

Duret brainstem hemorrhage (DBH) is a secondary lesion resulting from downward displacement of midline cerebral structures, classically associated with poor outcomes. However, its prognostic value remains debated.

CASE DESCRIPTION: A 22-year-old man with a Factor V Leiden mutation sustained a high-velocity traumatic brain injury. Initial CT revealed a right acute subdural hematoma with diffuse edema and signs of transtentorial herniation. Emergency decompressive craniectomy allowed hematoma evacuation and intracranial pressure control. Serial imaging demonstrated the chronological sequence of a DBH, from initial interpeduncular subarachnoid bleeding to a focal upper brainstem parenchymal hemorrhage and subsequent resorption. The patient showed excellent neurological and cognitive recovery after autologous cranioplasty (MoCA score 27/30).

CONCLUSION

This case highlights the chronological evolution of Duret brainstem hemorrhage and suggests that its presence does not necessarily indicate a poor prognosis, particularly in young patients managed with timely decompressive surgery.