{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T06:33:39Z","timestamp":1774506819366,"version":"3.50.1"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2009,6]]},"abstract":"<jats:p>Brainstem hemorrhage can occur as a primary or secondary event in traumatic brain injury (TBI). Secondary brainstem hemorrhage that evolves from raised intracranial pressure and transtentorial herniation is referred to as Duret hemorrhage. Duret hemorrhage following TBI has been considered an irreversible and terminal event. The authors report on the case of a young adult patient with TBI who presented with a low Glasgow Coma Scale score and advanced signs of cerebral herniation. She underwent an urgent decompressive hemicraniectomy for evacuation of an acute epidural hematoma and developed a Duret hemorrhage postoperatively. In accordance with the family's wishes, aggressive TBI monitoring and treatment in the intensive care unit was continued even though the anticipated outcome was poor. After a lengthy hospital course, the patient improved dramatically and was discharged ambulatory, with good cognitive functioning and a Glasgow Outcome Scale score of 4. Duret hemorrhage secondary to raised intracranial pressure is not always a terminal event, and by itself should not trigger a decision to withdraw care. Aggressive intracranial monitoring and treatment of a Duret hemorrhage arising secondary to cerebral herniation may enable a good recovery in selected patients after severe TBI.<\/jats:p>","DOI":"10.3171\/2008.8.jns08314","type":"journal-article","created":{"date-parts":[[2008,11,14]],"date-time":"2008-11-14T15:18:18Z","timestamp":1226675898000},"page":"1242-1246","source":"Crossref","is-referenced-by-count":32,"title":["Survival with good outcome after cerebral herniation and Duret hemorrhage caused by traumatic brain injury"],"prefix":"10.3171","volume":"110","author":[{"given":"Shirley I.","family":"Stiver","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Brain and Spinal Injury Center, University of California San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alisa D.","family":"Gean","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Radiology, School of Medicine; and"},{"name":"Brain and Spinal Injury Center, University of California San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoffrey T.","family":"Manley","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Brain and Spinal Injury Center, University of California San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-08314","series-title":"J Clin Pathol","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.1136\/jcp.33.12.1132","article-title":"Brain damage in fatal non-missile head injury","volume":"33","author":"Adams","year":"1980"},{"key":"b2-08314","series-title":"Neuroradiology","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1007\/s002340050739","article-title":"Consequences of the anatomy of deep venous outflow from the brain","volume":"41","author":"Andeweg","year":"1999"},{"key":"b3-08314","series-title":"Brain","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1093\/brain\/93.2.381","article-title":"Recovery from decerebration","volume":"93","author":"Brendler","year":"1970"},{"key":"b4-08314","series-title":"Ann Neurol","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1002\/ana.410010613","article-title":"Survival with permanent midbrain dysfunction after surgical treatment of traumatic subdural hematoma: the clinical picture of a Duret hemorrhage?","volume":"1","author":"Caplan","year":"1977"},{"key":"b5-08314","series-title":"Cerebrovasc Dis","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1159\/000071120","article-title":"The prognostic impact of clinical and CT parameters in patients with pontine hemorrhage","volume":"16","author":"Dziewas","year":"2003"},{"key":"b6-08314","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"52","DOI":"10.3171\/jns.1952.9.1.0052","article-title":"Recovery from the decerebrate state associated with supratentorial space-taking lesions","volume":"9","author":"Freedman","year":"1952"},{"key":"b7-08314","series-title":"Arch Pathol","first-page":"402","article-title":"Autopsy findings in head injuries from blunt forces. 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