Stiver Shirley I, Gean Alisa D, Manley Geoffrey T
Departments of Neurosurgery, University of California San Francisco, California, USA.
J Neurosurg. 2009 Jun;110(6):1242-6. doi: 10.3171/2008.8.JNS08314.
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.
脑干出血可作为创伤性脑损伤（TBI）的原发性或继发性事件发生。由颅内压升高和经天幕疝演变而来的继发性脑干出血称为杜雷氏出血。TBI后的杜雷氏出血一直被认为是不可逆转的终末期事件。作者报告了一例年轻成年TBI患者的病例，该患者格拉斯哥昏迷量表评分较低且有脑疝的晚期体征。她接受了紧急减压性颅骨切除术以清除急性硬膜外血肿，并在术后出现了杜雷氏出血。尽管预期结果不佳，但根据家属的意愿，重症监护病房仍继续对TBI进行积极监测和治疗。经过漫长的住院过程，患者显著好转并出院，能够行走，认知功能良好，格拉斯哥预后量表评分为4分。颅内压升高继发的杜雷氏出血并不总是终末期事件，其本身不应引发放弃治疗的决定。对脑疝继发的杜雷氏出血进行积极的颅内监测和治疗，可能使部分严重TBI患者实现良好恢复。
