Abstract
Primary pontine hemorrhage caused by vascular malformation is considerably rare in adults, especially above 50 years old. Case report. A 57 years old man admitted to the hospital because of sudden onset of vertigo, vomiting, headache and weakness of the left extremities on Feburuary 7, 1984. Blood pressure was 136/70 mmHg on add-mission. Neurological examination revealed consciousness disturbance (lethargy), neck stiffness, mild left sided hemiparesis, right sided ataxia, conjugate deviation of the eyes to the left and right sided Homer's syndrome. CT scan revealed small localized hematoma in the right upper pontine tegmentum associated with massive ventricular hemmorrhage (Fig. 1). Two days after the admission, his consciousness level was declined. CT scan revealed marked obstructive hydrocephalus (Fig. 2). Conservative anti-brain edema therapy was effective and he became alert following two weeks. Cerebral angiography revealed small arteriovenous malformation which was feeded from right superior cerebellar artery (Fig. 3). Enhanced CT scan examined 3 months after the onset showed a small enhanced spot in low density area in the right lateral tegmentum of the upper pons (Fig. 4). These findings indicated that the cause of pontine hemorrhage in this case was rupture of the arteriovenous malformation.
