[Spontaneous pontine hemorrhage. An analysis of 38 cases]

In 38 patients suffering from spontaneous pontine hemorrhages arterial hypertension was the most common risk factor. 31 patients, of whom 30 died, suffered centro-paramedian pontine hemorrhage leading to coma, hypertensive crisis, respiratory failure, cardiac arrhythmia, miosis and tetraparesis. Most cases showed involvement of the mesencephalon [17] and fourth ventricle [14]. The other seven patients demonstrated dorsotegmental [5] or hemipontine [2] hemorrhages with complex neuroophthalmologic signs, other cranial nerve lesions, and ataxia or hemiparesis; all these patients survived, some even without neurological deficit. In most cases, arteriosclerotic hemorrhages of pontine vessels occurred; in rare cases arterial malformations [4] and anticoagulants [4] were responsible for the bleeding. Clinical signs, CT scans and MRT investigations led to the diagnosis. EEG and evoked potentials allowed statements regarding localisation and prognosis. Treatment was limited in most cases to conservative intensive care; in one case a ventricular shunt was implemented, and in two cases pontine hemorrhages in the presence of arteriovenous and cavernous angiomas were removed.