Post by neurology admin on Mar 28, 2012 2:32:31 GMT -5
Pontine haemorrhageA pontine haemorrhage, a form of intracranial haemorrhage, is usually the result of poorly controlled chronic hypertension and carries a very poor prognosis.
Haemorrhage into the pons can of course also be secondary to underlying lesions (e.g. cavernous malformations and tumours). This article restricts itself to primary pontine haemorrhages.
EpidemiologyTypically patients are elderly with a long history of poorly controlled hypertension.
Clinical presentationPatients present with sudden and precipitous neurological deficit. Depending on the speed at which the haematoma enlarges and the exact location, presentation may include 1:
decreased level of consciousness : most common
long tract signs
cranial nerve palsies
seizures
Cheyne-Stokes respiration
Pathology
As is the case with penetrating arteries into the basal ganglia, the penetrating arteries from the basilar artery extending into the pons are subject to lipohyalinosis as a result of poorly controlled hypertension 1. This renders the vessel wall prone to rupture. The larger paramedian perforators are more commonly the culprit vessels 1.
Radiographic featuresCT
CT of the brain is usually the first, and often the only, investigation obtained upon presentation. Features typical on an acute intraparenchymal haemorrhage are noted, usually located centrally within the pons (on account of the larger paramedian perforators usually being the site of bleeding).
The haematoma more frequently extends in a rostro-caudal direction along the traversing long tracts, than laterally into the middle cerebellar peduncles. Usually the haematoma does not extend beyond the pontomedullary junction inferiorly and the inferior midbrain superiorly 1.
These haematomas frequently rupture into the 4th ventricle 1.
Treatment and prognosisPontine haemorrhages have a poor prognosis, with large bleeds being almost universally fatal. Surgical evacuation of the clot is usually not performed.
In smaller haemorrhages, medical management and treatment of hydrocephalus with extraventricular drains may be life saving, often with significant residual handicap.
source: radiopaedia.org/articles/pontine-haemorrhage
Haemorrhage into the pons can of course also be secondary to underlying lesions (e.g. cavernous malformations and tumours). This article restricts itself to primary pontine haemorrhages.
EpidemiologyTypically patients are elderly with a long history of poorly controlled hypertension.
Clinical presentationPatients present with sudden and precipitous neurological deficit. Depending on the speed at which the haematoma enlarges and the exact location, presentation may include 1:
decreased level of consciousness : most common
long tract signs
cranial nerve palsies
seizures
Cheyne-Stokes respiration
Pathology
As is the case with penetrating arteries into the basal ganglia, the penetrating arteries from the basilar artery extending into the pons are subject to lipohyalinosis as a result of poorly controlled hypertension 1. This renders the vessel wall prone to rupture. The larger paramedian perforators are more commonly the culprit vessels 1.
Radiographic featuresCT
CT of the brain is usually the first, and often the only, investigation obtained upon presentation. Features typical on an acute intraparenchymal haemorrhage are noted, usually located centrally within the pons (on account of the larger paramedian perforators usually being the site of bleeding).
The haematoma more frequently extends in a rostro-caudal direction along the traversing long tracts, than laterally into the middle cerebellar peduncles. Usually the haematoma does not extend beyond the pontomedullary junction inferiorly and the inferior midbrain superiorly 1.
These haematomas frequently rupture into the 4th ventricle 1.
Treatment and prognosisPontine haemorrhages have a poor prognosis, with large bleeds being almost universally fatal. Surgical evacuation of the clot is usually not performed.
In smaller haemorrhages, medical management and treatment of hydrocephalus with extraventricular drains may be life saving, often with significant residual handicap.
source: radiopaedia.org/articles/pontine-haemorrhage