The eyes have it: duret haemorrhage after traumatic subdural haematoma

Description A 51-year-old woman with no significant medical history was found collapsed at work having sustained a head strike. The patient was able to be discharged home after a short period of rehabilitation with persisting restricted eye movements but no significant functional impairment. Duret haemorrhage, also known as secondary brainstem haemorrhage, occurs as a result of transtentorial herniation of the brain in the context of acute trauma (eg, subdural haematoma).1 2 It is hypothesised to occur as a result of the downward pressure shearing small mobile blood vessels within the brainstem from the relatively immobile basilar artery.2 Surgical decompression can also result in haemorrhage from reperfusion injury.2 Due to their location, there is an association with poor prognosis of death or severe neurological disability, which often results in earlier withdrawal of life-sustaining therapies.2 Our case highlights the caution required when assessing prognosis in patients with Duret haemorrhage.