Abstract
Twenty cases of primary pontine hemorrhage (PPH) were diagnosed by CT scan over a period from June 1979 to March 1982, and were treated conservatively. They were classified into four types according to their outcome. Five cases in Type I showed a full recovery or could resume most activities (ADLI or II). The initial clinical picture of this type was characterized by alertness, no disturbance of autonomic function, and mild hemiparesis. CT scan demonstrated a small hematoma which was localized in the unilateral region or midportion of the pontine tegmentum. In four cases, the largest diameter of the hematoma on a transverse section through the pons was less than 20 mm, and its extension was limited to 2 slices, (each 10 mm in width). EEG performed on two patients were normal. Three cases of. Type II recovered to daily life partially assisted (ADL III). Clinical manifestations consisted of mild disturbance of consciousness, severe hemiplegia, cerebellar signs, and minor autonomic dysfunction. Hematoma was located in the bilateral pontine tegmentum and partially involved the pontine basis. The size of hematoma was less than 30 mm and its extension was 2 to 3 slices. EEG performed on one patient consisted of alpha activity with some theta waves. Seven cases of Type III were severely disabled in prolonged coma or the “locked-in” syndrome (ADL IV). Their clinical findings were coma in four patients, tetraplegia in seven, decerebrate regidity in two, respiratory disturbance in two, and hypertension in three. Hematoma was located in the entire pontine tegmentum and unilateral pontine basis extending to the midbrain. The size of hematoma was less than 30 mm in five patients and more than 31 mm in two. EEG was carried out on five patients in the comatose state. Alpha-pattern coma was present in two cases and beta-coma was observed in two. All five cases of Type IV died within a few days after the onset. The clinical picture was coma, tetraplegia, respiratory failure, hyperthermia, and hypertension in all cases. Hematoma involved the entire tegmentum and basis pontis and extended to the cerebellum and midbrain. The size of hematoma was less than 30 mm in two patients and more than 31 mm in three. The sagittal extension was 3 to 6 slices. The importance of systematic investigations of the clinical, computed tomographic, and electroencephalographic findings were recognized.
