Abstract
It is widely accepted that the prognosis of primary pontine hemorrhage depends on transverse and longitudinal diameters of the hematoma. However, no systematic evaluation has yet been attempted on the relation between the volume and direction of extension of the hematoma and vital prognosis of the patients. The present clinical study was aimed at investigating on these themes.
The subjects were 22 patients with primary pontine hemorrhage. Duration from the onset was 2.7± 5.2 hours (mean ± SD). On admission, 3 cases were in somnolence, 4 in stupor, 10 in semicoma and 5 in coma. Eleven out of the 22 cases died in 2.3 ± 4.3 days from the onset. The volume of the hematomas was calculated from CT scan image taken on the day of admission, and was classified in 3 groups; it wa smaller than 5 ml in 8 cases (Group I), 520 ml in 10 (Group II) and larger than 20 ml in 4 (Group III).
All of the group I and 3 cases of the group II survived, while all of the group III and 7 cases of the group II died. Out of the 10 cases of the group II, three had hematomas extending toward cerebellum, and all of them died. Six cases of the group II had hematomas extending toward midbrain, and 3 of them survived although their hematomas were larger than those in the case with extension only toward cerebellum. In all of the group III, the hematomas extended toward both cerebellum and midbrain in addition to ventricular ruptures.
From the above data, vital prognosis is good in the patients with hematomas smaller than 5 ml, while it is absolutely poor in the cases with hematomas larger than 20 ml. With the hematoma between 5 and 20 ml, the possibility of survival is expected only in the cases with extension of hematoma toward midbrain.
