Neuroanatomy: Duret haemorrhage: practice question

A Anatomy 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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Anatomy · Neuroanatomy: Duret haemorrhage

Sample item

A comatose patient with a large temporal haematoma and a fixed dilated pupil dies, and autopsy shows linear midline haemorrhages in the midbrain and upper pons. Which vessels have been torn?

AParamedian perforating branches of the basilar arteryBLenticulostriate branches of the middle cerebral arteryCPosterior communicating artery perforatorsDCircumferential branches of the superior cerebellar artery

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

The answer and the reasoning

A. Paramedian perforating branches of the basilar artery

Downward displacement of the brainstem in transtentorial herniation stretches the paramedian perforating branches of the basilar artery, causing Duret haemorrhages. They signal a terminal stage of herniation.

Option by option

A. Paramedian perforating branches of the basilar artery (correct)
Correct. Stretching of basilar paramedian perforators produces the characteristic midline Duret haemorrhages.
B. Lenticulostriate branches of the middle cerebral artery
Lenticulostriate arteries supply the basal ganglia and are not tethered at the brainstem midline.
C. Posterior communicating artery perforators
Posterior communicating perforators supply the hypothalamus and thalamus.
D. Circumferential branches of the superior cerebellar artery
Circumferential branches run around the lateral brainstem rather than penetrating the midline.

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.

Questions about this Anatomy question

What is the answer to this Anatomy question?

The best answer is A, Paramedian perforating branches of the basilar artery. Downward displacement of the brainstem in transtentorial herniation stretches the paramedian perforating branches of the basilar artery, causing Duret haemorrhages.

Why is "Lenticulostriate branches of the middle cerebral artery" not the answer?

Lenticulostriate arteries supply the basal ganglia and are not tethered at the brainstem midline.

Why is "Posterior communicating artery perforators" not the answer?

Posterior communicating perforators supply the hypothalamus and thalamus.

Why is "Circumferential branches of the superior cerebellar artery" not the answer?

Circumferential branches run around the lateral brainstem rather than penetrating the midline.

What concept does this question test?

It tests Neuroanatomy: Duret haemorrhage in Anatomy. They signal a terminal stage of herniation.

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 Neuroanatomy: Duret haemorrhage?

Learn every nerve by its route, its muscles and what a lesion looks like at the bedside. That one habit answers a large share of questions. Then use the flashcards and the other Anatomy 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.