Abstract
Developments of hematomas and sites of bleeding were investigated and the volumes of the hematomas were measured with a modular optical planimeter in fifteen postmortem cases with primary pontine hemorrhage.
This disease was seen to be prevalent in cases aged between 40 and 70. Duration between onset and death varied from three hours to nine and half months, most of the cases dying within a week from the onset.
Clinical symptomatology was as follows : Disturbance of consciousness (most of cases showed coma), quadriplegia or hemiplegia, respiratory disturbance. myosis, decerebrate rigidity, etc.
Postmortem examination disclosed primary pontine hemorrhage could be divided into two types; tegmentobasilar (TB type) and tegmental (T type). The former type was seen in twelve cases, the latter in three cases. In TB type, primary sites of the hemorrhage were from the border zone of tegmental and basilar parts of the midpons. On the other hand, in T type, bleeding seemed to start from one side of the pontine tegmentum.
Measured volumes of hematomas varied from 0.5 ml to 96.99 ml (under 10 ml in T type, less than 20 ml in TB type within the pens, less than 40 ml in TB type with development of hematoma in the midbrain, and more than 40 ml in TB type with development of hematoma in the diencephalon). Developments of the hematoma were shown to spread in three directions in TB type. (1) Development into opposite side; (2) Development in ventrodorsal direction (hematomas can break into the fourth ventricle); (3) Upward development which causes midbrain or diencephalic hemorrhage. T type seemed not to develop out of the tegmentum on one side. No development to the medulla oblongata occurs in any type.
We conclude from findings of the fifteen postmortem cases that the primary pontine hemorrhage can be divided into two types, which show different sites of hemorrhage, different volumes, and different developments of hematomas.
