Spontaneous pontine hemorrhages have the highest mortality rate. Posterior pontine hemorrhage has a poor prognosis, although more research is required in this area. Herein, we attempted to determine the prognosis of pontine hemorrhage by schematically illustrating the volume and location and developing a scoring model to predict the relationship between initial hemorrhage characteristics and clinical outcome. Methods This multicenter, retrospective study was conducted between January 2010 and December 2019. We developed a scoring model using computed tomography (5-mm sections) to plot the location and volume of pontine hemorrhages. All hemorrhage volumes were classified as mild (0.5-5 cm 3 ), moderate (5-10 cm 3 ), or severe (10-16 cm 3 ). ResultsAs the pontine hemorrhage volume increased, the Glasgow Coma Scale (GCS) and Eastern Cooperative Oncology Group scores (ECOG) were significantly lower, while the modified Rankin Scale (mRS) was higher (p<0.001). In the mild and moderate groups, the GCS recovered from 11.36 to 12.89 and 4.68 to 7.31 over 24 months, respectively. The mRS improved from 3.25 to 2.82 in the mild hemorrhage group but deteriorated in the moderate hemorrhage group from 4.93 to 5.24 over 24 months. More extensive pontine hemorrhages were associated with shorter life expectancy. The mild, moderate, and severe groups showed 32.79%, 89.29%, and 100% mortality, respectively (p<0.0001). The anterior and posterior hemorrhage groups had 69.44% and 42.86% mortality (p=0.0020), respectively. ConclusionAccording to our prognosis model, initial hemorrhage volume was the most significantly related neurological outcome. Hemorrhage location showed no relationship with neurological outcome. However, anterior upper pontine hemorrhage volume was correlated with shortened survival time.

The thrombotic thrombocytopenic purpura (TTP) is not a common disease entity and presents multiple systemic symptoms, constellation of ambiguous GI complaints, fever, neurologic deficits and renal failure. As well as the mentioned symptoms, unexpected atypical symptoms related to small vessel occlusion could be complicated. In this case, multifocal cerebral infarction and non-territorial cardiac ischemia was noted. Surgery-related TTP is not common and needed to differentiate from surgery-related complications. We reported orthopedic surgery-related clinical vignette of TTP treated by plasmapheresis and the related literature would be reviewed.