Good Outcome in a Patient with Massive Pontine Hemorrhage

Massive pontine hemorrhage with comatose condition has a poor prognosis and bad outcome despite adequate surgical treatment. However, this case report gives a different result. Providing adequate prophylactic treatment to prevent secondary brain injury resulted in a very good recovery at the 6-month follow-up. A 42-year-old man with a history of heavy smoking and poorly controlled blood pressure (BP) developed acute loss of consciousness. He was then brought to the emergency room (ER) in 30 min. At the ER, his Glasgow coma scale score was E1M2V1 and the BP was high. An emergency computed tomography (CT) scan of the brain showed massive hematoma in the pons with intraventricular extension. He was admitted to the intensive care unit with close monitoring of both vital signs and neurosigns. External ventricular drainage was inserted to control intracranial pressure and then removed in only 5 days after adequate control. The patient returned to a good recovery status in 6 months with a modified Rankin scale score of 2 and the CT brain scan showed a small cavity-like lesion at the hemorrhage area. Massive hemorrhage and low consciousness may not truly indicate a poor prognosis in patients with pontine hematoma. Medical and surgical treatments are still needed to control intracranial pressure for prophylaxis of secondary brain injury. Restoration of neuronal functions was achieved after resolution of the hematoma.