Recovery from primary pineal region hemorrhage

A 38-year-old with primary pineal region hemorrhage and acute hydrocephalus was subjected to an external shunt. CT scanning showed complete resolution of the hemorrhage and hydrocephalus. The patient recovered.

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Sommario Viene descritto un caso di emorragia primitiva della regione pineale con idrocefalo acuto in un paziente di 38 anni sottoposto a derivazione liquorale esterna. Il controllo TAC ha mostrato la completa risoluzione dell'emorragia e dell'idrocefalo.

     

Ataxic hemiparesis in patients with primary pontine hemorrhage

Two patients with small primary pontine hemorrhage developed a syndrome identical to ataxic hemiparesis, one of the lacunar syndromes of Fisher. The possible mechanisms of the homolateral cerebellar signs, pyramidal signs, and dysarthria are discussed. Lesions of the ipsilateral pontine nuclei may be responsible for the homolateral ataxia.     

原发性脑桥出血患者41例预后分析

目的 探讨原发性脑桥出血患者预后及其影响因素。方法 以温州卒中登记库为基础,前瞻性连续登记2007年4月至2009年4月温州医学院附属第一医院从发病到入院时间＜24h,并被诊断为原发性脑桥出血的患者。随访1年,记录患者生存状态。应用Kaplan-Meier法进行生存率分析,应用Cox比例风险模型对可能影响患者1年生存率的因素进行分析。结果 共收集原发性脑桥出血患者41例,男性27例(65.9％),女性14例(34.2％)。截止随方终止时,死亡患者共25例,总病死率为61.0％,中位生存时间为(80.0±54.4) d(95％ CI0～186.64)。不同部位的原发性脑桥出血患者1年病死率比较,被盖型(2/11)与基底型(16/22)相比差异有统计学意义(X2 =8.800,P=0.003),被盖型(2/11)与混合型(7/8)相比差异有统计学意义(x2=8.927,P=0.003)。1年生存组平均血肿体积为(3.043±1.718) ml,死亡组平均血肿体积为(5.984±2.707) ml,两组相比,t=3.661,P=0.001。Cox比例风险模型显示,影响原发性脑桥出血患者1年死亡的主要冈素有：血肿部位(RR =2.428,95％ CI1.055 ～5.587),血肿体积(RR= 1.283,95％CI1.044- 1.577),入院时GCS 评分(RR= 3.389,95％CI 1.177～9.756)。结论 原发性脑桥出血患者血肿位于脑桥被盖部、血肿体积＜4 ml、入院时GCS评分＞8分时1年预后较好。     

Clinical and neuroradiological predictors of mortality in patients with primary pontine hemorrhage

BACKGROUND AND PURPOSE: Primary pontine hemorrhage (PPH) accounts approximately for about 5-10% of intracranial hemorrhages, and PPHs are known to have a much less uniform prognosis. We aimed to evaluate the clinical and radiological predictors affecting the mortality in 32 patients with PPH. MATERIAL AND METHODS: We retrospectively evaluated the data of 32 patients with PPH admitted to our clinic between 1994 and 2004. We divided the patients into two groups: (1) patients who survived (14 patients), and (2) patients who died (18 patients). The two groups were compared for age, gender, diabetes mellitus, hypertension, initial clinical status, initial GCS, pupillary abnormalities, ophthalmoparesis, volume and localisation of hemorrhage, intraventricular and extrapontine extension, necessity of mechanical ventilation and hydrocephalus. The hematoma volumes were measured with the formulation described by Broderick. RESULTS: Eighteen patients (56%) died and 14 patients (44%) survived. The patients who died (61.3 +/- 8.8) were older than the survivors (56.4 +/- 11.0), but the difference was not statistically significant. The mean GCS was 4.4 +/- 0.2, the mean hematoma volume was 9.9 +/- 3.3 ml for patients who died and the mean GCS was 10.1 +/- 3.3, the mean hematoma volume was 3.3 +/- 1.2 ml for survivors (p < 0.001). Coma on admission (p = 0.001), extrapontine extension (p = 0.001), intraventricular extension (p = 0.019), necessity of mechanical ventilation (p = 0.007), hydrocephalus (p = 0.024), massive and bilateral tegmental localisation (p = 0.006) were found statistically significant predictors for mortality with univariate comparison, and coma on admission (p = 0.038) was the only significant predictor with multivariate regression analysis. CONCLUSION: In patients with PPH, it is important to know the prognostic factors for mortality for planning the treatment protocol, and coma and bad clinical status on admission was found the only significant prognostic predictor for mortality with multivariate regression analysis.     

Clinical and neuroradiological predictors of mortality in patients with primary pontine hemorrhage

Background and purposePrimary pontine hemorrhage (PPH) accounts aproximately for about 5–10% of intracranial hemorrhages, and PPHs are known to have a much less uniform prognosis. We aimed to evaluate the clinical and radiological predictors affecting the mortality in 32 patients with PPH.Material and methodsWe retrospectively evaluated the data of 32 patients with PPH admitted to our clinic between 1994 and 2004. We divided the patients into two groups: (1) patients who survived (14 patients), and (2) patients who died (18 patients). The two groups were compared for age, gender, diabetes mellitus, hypertension, initial clinical status, initial GCS, pupillary abnormalities, ophthalmoparesis, volume and localisation of hemorrhage, intraventricular and extrapontine extension, necessity of mechanical ventilation and hydrocephalus. The hematoma volumes were measured with the formulation described by Broderick.ResultsEighteen patients (56%) died and 14 patients (44%) survived. The patients who died (61.3 ± 8.8) were older than the survivors (56.4 ± 11.0), but the difference was not statistically significant. The mean GCS was 4.4 ± 0.2, the mean hematoma volume was 9.9 ± 3.3 ml for patients who died and the mean GCS was 10.1 ± 3.3, the mean hematoma volume was 3.3 ± 1.2 ml for survivors (p < 0.001). Coma on admission (p = 0.001), extrapontine extension (p = 0.001), intraventricular extension (p = 0.019), necessity of mechanical ventilation (p = 0.007), hydrocephalus (p = 0.024), massive and bilateral tegmental localisation (p = 0.006) were found statistically significant predictors for mortality with univariate comparison, and coma on admission (p = 0.038) was the only significant predictor with multivariate regression analysis.ConclusionIn patients with PPH, it is important to know the prognostic factors for mortality for planning the treatment protocol, and coma and bad clinical status on admission was found the only significant prognostic predictor for mortality with multivariate regression analysis.     

Trigeminal neuropathy in pontine hemorrhage

The case of a 23-year-old patient with trigeminal neuropathy due to a spontaneous lateral tegmental pontine hemorrhage is reported. The differential diagnosis of trigeminal neuropathy is shortly described.     

Clinicopathological study of pontine hemorrhage

This report concerns a clinico-pathological study of 60 patients afflicted with primary pontine hemorrhage. The illness was fatal in 43, 17 patients survived. Ophthalmic signs, autonomic disturbances and transient visual hallucination were observed and discussed. A ruptured microaneurysm within the border of a pontine hematoma was detected in this study, and in the first report of such a finding.     

Recovery after central pontine myelinolysis

Summary Central pontine myelinolysis (CPM) is known to be almost universally fatal. Most published cases are based on autopsy reports, whereas antemortem diagnosis is rare. We present a case in which the diagnosis of CPM was confirmed by computed tomography (CT); the patient had two symptoms not previously reported and made a remarkable recovery.

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Zusammenfassung Es ist bekannt, daß die zentrale pontine Myelinolyse praktisch immer tödlich endet. Die meisten veröffentlichten Fälle sind auf Grund der Autopsie diagnostiziert worden, während eine prämortale Diagnose selten ist. Der vorliegende Fall einer zentralen pontinen Myelinolyse wurde durch Computertomographie intra vitam bestätigt. Der Patient wies zwei früher nicht beschriebene Symptome auf und erholte sich in bemerkenswerter Weise.

     

Auditory brain-stem potentials with unilateral pontine hemorrhage

Although there have been extensive anatomical and physiological studies in animals, the actual neural sources, or even the laterality, of some components of auditory brain-stem evoked potentials in humans are uncertain. We studied these responses in a 56-year-old patient who had a clearly demarcated pontine hemorrhage on the right side. The patient was somnolent, with dense left hemiplegia and signs of involvement of right cranial nerves V, VI, and VII. Stimulation of the left ear (ie, contralateral to the lesion) evoked a normal series of waves with clearly resolved positive components peaking at 2.0, 3.3, 4.8 (wave IV), and 6.0 ms (wave V). Stimulation of the right ear (ie, ipsilateral to the lesion) evoked only waves I, III, and IV. These results suggest that a pathway ipsilateral to the stimulated ear is necessary and sufficient for generation of auditory wave V and that wave IV is generated in bilateral pathways.     

Acquired pendular nystagmus after pontine hemorrhage]

A 60-year-old hypertensive woman had a pontine hemorrhage that caused slight right hemiplegia, deep sensory disturbance on her right side and dysarthria. Three months after the stroke, she was transferred to our hospital for rehabilitation. Approximately 6 months later, she gradually began to complain of the visual oscillation. Continual, unceasing conjugate vertical/rotatory eye movements were observed. Fixation was momentary at best because of an inability to dampen the spontaneous eye movements. Electrooculography (EOG) showed bilateral vertical/rotatory sinusoidal eye movements of 2.5 Hz frequency and 10- to 35-degree amplitude. Both vertical and horizontal optokinetic nystagmus were absent. Caloric stimulation did not evoke any responses bilaterally. There were no rhythmical movements at similar frequencies in other parts of the body such as palatal myoclonus. MRI revealed not only hematoma mainly at the dorsal pontine tegmentum but also hypertrophy of the inferior olive nucleus, suggesting disruption of the central tegmental tract. Lesions of this tract may be one cause of pendular nystagmus. Several drug therapies were investigated for the nystagmus. There was no response to baclofen 15 mg. Trihexyphenidyl 4 mg was discontinued because of drug-induced hallucinations. Tiapride 600 mg and phenobarbital 90 mg were each slightly effective in reducing both frequency and amplitude of nystagmus. Treatment with clonazepam 1 mg resulted in the striking disappearance of nystagmus. She was aware of this and no longer experienced oscillopsia. Despite the visual benefit, however, the patient did not wish to continue this drug because of drowsiness and muscle relaxation. The potential long-term therapeutic application of clonazepam should be further investigated. To our knowledge, there have been no reports of successful treatment in acquired pendular nystagmus with clonazepam. Therefore, based on this favorable experience, it is suggested that clonazepam should be added to the list of potential therapies for pendular nystagmus.