Injuries and wounds: Duret haemorrhage: practice question

A Forensic Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Forensic Medicine · Injuries and wounds: Duret haemorrhage

Sample item

A man hit by a vehicle remains in coma and dies 30 hours after a severe head injury. Autopsy shows a large cerebral swelling, downward displacement of the brainstem, and small flame-shaped haemorrhages in the midbrain and upper pons. What are these haemorrhages?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Secondary brainstem haemorrhages from downward herniation stretching perforating vessels

Duret haemorrhages are secondary brainstem haemorrhages that follow raised intracranial pressure and downward transtentorial herniation, which stretches and tears the perforating branches of the basilar artery. They are a sign that the brain was swollen before death and are not a direct impact injury. They are usually midline in the midbrain and pons.

Option by option

  • A. Secondary brainstem haemorrhages from downward herniation stretching perforating vessels (correct)

    Correct. Herniation stretches the perforating vessels and causes secondary haemorrhage.

  • B. Hypertensive pontine haemorrhage from a ruptured vessel

    Hypertensive pontine haemorrhage is a spontaneous event and this man had severe trauma with herniation.

  • C. Gliding contusions of the parasagittal white matter

    Gliding contusions lie in the white matter near the cerebral cortex, not in the brainstem.

  • D. Primary contusions from direct impact on the brainstem

    Primary brainstem contusions result from direct trauma and are rarely small midline flame-shaped lesions.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is A, Secondary brainstem haemorrhages from downward herniation stretching perforating vessels. Duret haemorrhages are secondary brainstem haemorrhages that follow raised intracranial pressure and downward transtentorial herniation, which stretches and tears the perforating branches of the basilar artery.

Why is "Hypertensive pontine haemorrhage from a ruptured vessel" not the answer?

Hypertensive pontine haemorrhage is a spontaneous event and this man had severe trauma with herniation.

Why is "Gliding contusions of the parasagittal white matter" not the answer?

Gliding contusions lie in the white matter near the cerebral cortex, not in the brainstem.

Why is "Primary contusions from direct impact on the brainstem" not the answer?

Primary brainstem contusions result from direct trauma and are rarely small midline flame-shaped lesions.

What concept does this question test?

It tests Injuries and wounds: Duret haemorrhage in Forensic Medicine. They are a sign that the brain was swollen before death and are not a direct impact injury. They are usually midline in the midbrain and pons.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Injuries and wounds: Duret haemorrhage?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.