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Increased Intracranial Pressure ll: Pathophysiology

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...

Brainstem

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The brainstem, located inferior to the brain and superior to the spinal cord, serves as a bridge between the cerebrum and the spinal cord. It plays a vital role in relaying information and controlling critical life functions. It comprises three primary regions: the midbrain, pons, and medulla oblongata.
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The midbrain is located beneath the diencephalon and connects the cerebrum with the lower parts of the brain. The cerebral peduncles are prominent midbrain structures that house the...

Increased Intracranial Pressure l: Introduction

Increased Intracranial Pressure l: Introduction

Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...

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Equilibrium and Balance

Equilibrium and Balance

The inner ear assumes dual functionalities of auditory perception and equilibrium maintenance. The vestibule is the organ responsible for balance. This organ contains mechanoreceptors, specifically hair cells, endowed with stereocilia, which aid in deciphering information regarding the position and motion of our heads. Two intrinsic components, the utricle and saccule, help perceive head position, while the semicircular canals track head movement. Neurological messages initiated in the...

Cerebral Edema ll: Pathophysiology

Cerebral Edema ll: Pathophysiology

Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...

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Updated: Jun 29, 2026

Massive Pontine Hemorrhage by Dual Injection of Autologous Blood

Massive Pontine Hemorrhage by Dual Injection of Autologous Blood

Published on: May 29, 2021

Pontine warning syndrome.

Gustavo Saposnik¹, Lyne Noel de Tilly, Louis R Caplan

¹Stroke Research Unit, Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, 55 Queen St E, Ste 931, Toronto ONM5C1R6, Canada. saposnikg@smh.toronto.on.ca

Archives of Neurology

|October 15, 2008

Summary

This summary is machine-generated.

A rare stroke case highlights "pontine warning syndrome," characterized by fluctuating symptoms preceding a paramedian pontine infarct due to branch disease. This syndrome indicates a high risk of stroke.

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Area of Science:

Neurology
Vascular Neurology
Neuroimaging

Background:

Stroke mechanisms in patients with fluctuating symptoms are poorly understood.
The role of branch atherosclerotic disease in pontine infarcts requires further investigation.

Observation:

A 63-year-old male with hypertension, diabetes, and dyslipidemia presented with fluctuating right-sided weakness and dysarthria.
The patient experienced transient episodes of horizontal gaze palsy with preserved consciousness.
Neurologic status fluctuated significantly, as indicated by NIH Stroke Scale scores ranging from 3 to 15.

Findings:

Neuroimaging revealed an acute left paramedian pontine infarct with a patent basilar artery.
Despite thrombolytic therapy, motor weakness fluctuations persisted for 12 hours.
Branch disease was identified as a likely cause of the pontine infarction.

Implications:

Introduction of the term "pontine warning syndrome" to describe recurrent, stereotyped episodes preceding pontine infarction.
This syndrome signifies a high risk of imminent basilar artery branch infarction and potential permanent deficits.
Recognizing pontine warning syndrome may improve early diagnosis and intervention for specific stroke types.