Pontine haemorrhage: a clinical analysis of 26 cases.

Abstract

SUMMARY Correlation with the size of the haematoma, neurological findings and prognosis was studied in 26 cases of hypertensive pontine haemorrhage, using CT. A good prognosis was found with no or mild disturbance of consciousness, normal pupils, and transverse diameter of the haematoma 20 mm or less. Most of the patients with poor prognosis became comatose within two hours of onset. Their pupils were dilated bilaterally, pin-point or anisocoric and the transverse diameter of the haematoma was over 20 mm.The prognosis in cases of pontine haemorrhage has been reported to be extremely poor,' but the widespread use of CT scanning has led to the discovery of small pontine haematomas which previously could not have been diagnosed. In such cases, the prognosis is not always unfavorable.2'4 We report the clinical symptoms, CT findings and prognosis of 26 patients with primary pontine haemorrhage. Materials and methodsAll cases of arteriovenous malformation and cryptic angioma were excluded leaving 26 cases of pontine haemorrhage brought to hospital within 24 hours of onset between July 1978 and April 1982 (table 1). Twenty were male and six were female, with ages ranging between 33 and 68 years (mean 50 years).Study was made of the symptoms at onset, level of consciousness on admission, pupillary and other cranial nerve findings and 10 mm thick slice CT findings in relation to the transverse and longitudinal diameters of the haematoma, the number of CT slices in which the haematoma was visible and the presence or absence of ventricular enlargement. Results(a) Clinical symptoms, therapy and prognosis The symptoms at onset were headache and vomiting in 10 patients, vertigo in seven, hemiparesis in six, loss of consciousness in five and unilateral sensory disturbance in two.

Predictors of surgical results in patients with primary pontine hemorrhage

“…Ventricular extension was only significant for mortality and hydrocephalus only for functional outcome in the univariate analysis; neither was associated with outcomes Large hematoma and severe disturbance of consciousness are commonly recognized as good predictors of mortality and unfavorable functional outcome in patients under medical treatment (3,9,10,15). It has been reported that survival is impossible if all 3 features including large paramedian pontine hemorrhage (PH), transverse diameter of hematoma ≥20 mm, and coma on admission are present in ppH patients (3).…”

Cause Is the Main Predictor of Outcome in Patients with Pontine Hemorrhage

“…In previous studies on pontine hemorrhage, patients harboring vascular malformations were typically excluded [6, 7, 12]or included in very small numbers [8, 11]. However, these series either predate the introduction of MRI – the only reliable noninvasive method to diagnose cavernous angiomas [14, 15]– or fail to report how often MRI was used.…”

“…The introduction of CT allowed the recognition that not only survival but also remarkable functional recovery was possible after a pontine hemorrhage [4, 5, 6, 7, 8, 9, 10]. Prognosis is highly dependent on clinical severity at presentation and the presence of certain radiological markers, such as hydrocephalus, bleeding size and extension into the midbrain and thalamus [11, 12].…”

Lateral pontine hemorrhage: reappraisal of benign cases.

“…5 " 1318 The transverse diameter of the hematoma has also been considered a prognostic factor. Masiyama et al 8 found a direct relation between the maximum transverse diameter of the hematoma seen in CT scans and the outcome. In their series, a diameter of < 2 0 mm was associated with favorable outcome.…”