Abstract
In 27 cases with primary pontine hemorrhage over a period from October 1979 to April 1983, we studied the correlations between clinical signs, computed tomographic findings and prognosis. The cases were consisted of 23 males and 4 females between 31 to 65 years with average age 50.0. They could be classified into four groups according to the clinical courses. 1) group of good recovery : ADL I, II (9 cases), 2) group of severe disability : ADL III, IV (3 cases), 3) group of death with complications (3 cases), 4) group of early death (12 cases). On admission, comatous state, ocular fixation, absence of light reaction and tetraplegia or decrebrate posture were the signs of bad prognosis. Respiratory disturbance was not always the sign of early death. In fact, three patients with abnormal respiration were in group of good recovery. On the CT, the horizontal extension of the hematoma was demonstrated by the diameter of the hematoma on the transverese section through the pons, and vertical extension was indicated by the number of slices (10 mm in width). The hematomas of the group of good recovery were less than 25 mm in diameter, and they were seen on less than 3 slices. The hematomas lager than this size were seen exclusively among the groups of death and severe disability. Furthermore, the rupture of hematoma into the IVth ventricle was the sign of bad prognosis. All cases were treated conservatively. We emphasize the importance of prevention of complications and respiratory care in the management of the pontine hemorrhage.
