Factors Determining the Outcome of Pontine Hemorrhage in the Absence of Surgical Intervention
Author(s)
Takafumi Nishizaki*,
Norio Ikeda,
Shigeki Nakano,
Takanori Sakakura,
Masaru Abiko,
Tomomi Okamura
ABSTRACT
Objectives and Importance: Although pontine hemorrhage is very often fatal, the clinical manifestations vary accord-ing to the location and extent of the hematoma. We investigated the prognostic factors of pontine hemorrhage by assessing clinical manifestation and CT findings in relation to outcome. Materials and Methods: The outcome and clinical features of 19 patients with pontine hemorrhage without surgical intervention were analyzed. The CT features of the hematoma were classified into four types: massive, tegmento-basilar, transverse oval, and small unilateral. The Glasgow Outcome Scale (GOS) was used to assess patient outcome (G, good recovery; MD, moderate disability; SD, severe disability, V, vegetative state, D, death) at discharge. Results: The outcome was MD in 7 cases, SD in 3, and D in 9. Eight of 9 patients with acute hydrocephalus died, whereas only one of 10 patients without hydrocephalus died (p < 0.01). Patients who survived until discharge tended to younger than those who died (61 and 77 years, p < 0.05). Death was more frequent among patients with a GCS score of >12, tetraparesis, or respiratory failure (p < 0.01, 0.05, 0.01, respectively). Four of 5 patients with CT evidence of massive hemorrhage died, and another patient became vegetative. The outcome in 6 patients with tegmento-basilar-type hematoma included D in 3, V in 2, and MD in 1, and that in 7 patients with transverse oval hematoma included D in 2, V in 1, SD in 1, and MD in 3. Five (65%) of the 8 patients with transverse oval or small unilateral hematomas were able to walk (MD) with or without assistance, whereas only 2 (18%) of 11 patients with tegmento-basilar-type and massive hematoma were ambulatory at discharge (p < 0.05). Conclu-sion: On the basis of CT classification, the functional prognosis of transverse oval pontine hemorrhage is as favorable as that of the small unilateral type.
Objectives and Importance: Although pontine hemorrhage is very often fatal, the clinical manifestations vary accord-ing to the location and extent of the hematoma. We investigated the prognostic factors of pontine hemorrhage by assessing clinical manifestation and CT findings in relation to outcome. Materials and Methods: The outcome and clinical features of 19 patients with pontine hemorrhage without surgical intervention were analyzed. The CT features of the hematoma were classified into four types: massive, tegmento-basilar, transverse oval, and small unilateral. The Glasgow Outcome Scale (GOS) was used to assess patient outcome (G, good recovery; MD, moderate disability; SD, severe disability, V, vegetative state, D, death) at discharge. Results: The outcome was MD in 7 cases, SD in 3, and D in 9. Eight of 9 patients with acute hydrocephalus died, whereas only one of 10 patients without hydrocephalus died (p < 0.01). Patients who survived until discharge tended to younger than those who died (61 and 77 years, p < 0.05). Death was more frequent among patients with a GCS score of >12, tetraparesis, or respiratory failure (p < 0.01, 0.05, 0.01, respectively). Four of 5 patients with CT evidence of massive hemorrhage died, and another patient became vegetative. The outcome in 6 patients with tegmento-basilar-type hematoma included D in 3, V in 2, and MD in 1, and that in 7 patients with transverse oval hematoma included D in 2, V in 1, SD in 1, and MD in 3. Five (65%) of the 8 patients with transverse oval or small unilateral hematomas were able to walk (MD) with or without assistance, whereas only 2 (18%) of 11 patients with tegmento-basilar-type and massive hematoma were ambulatory at discharge (p < 0.05). Conclu-sion: On the basis of CT classification, the functional prognosis of transverse oval pontine hemorrhage is as favorable as that of the small unilateral type.
Cite this paper
T. Nishizaki, N. Ikeda, S. Nakano, T. Sakakura, M. Abiko and T. Okamura, "Factors Determining the Outcome of Pontine Hemorrhage in the Absence of Surgical Intervention," Open Journal of Modern Neurosurgery, Vol. 2 No. 2, 2012, pp. 17-20. doi: 10.4236/ojmn.2012.22004.
T. Nishizaki, N. Ikeda, S. Nakano, T. Sakakura, M. Abiko and T. Okamura, "Factors Determining the Outcome of Pontine Hemorrhage in the Absence of Surgical Intervention," Open Journal of Modern Neurosurgery, Vol. 2 No. 2, 2012, pp. 17-20. doi: 10.4236/ojmn.2012.22004.
References
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[1] H. B. Dinsdale, “Spontaneous Hemorrhage in the Posterior Fossa. A Study of Primary Cerebellar and Pontine Hemorrhage with Observations on Their Pathogenesis,” Archives of Neurology, Vol. 10, No. 2, 1964, pp. 200-217. doi:10.1001/archneur.1964.00460140086011 [2] A. W. Epstein and J. H. Globus, “Primary Massive Intrapontine Hemorrhage: Clinical and Pathologic Survey,” Journal of Nervous and Mental Disease, Vol. 113, No. 3, 1951, pp. 260-267. [3] M. J. Kushner and S. B. Bressman, “The Clinical Manifestations of Pontine Hemorrhage,” Neurology, Vol. 35, No. 5, 1985, pp. 637-643. [4] A. Silverstein, “Primary Pontine Hemorrhage. A Review of 50 Cases,” Confinia Neurologica, Vol. 29, No. 1, 1967, pp. 33-46. doi:10.1159/000103674 [5] N. Goto, M. Kaneko, Y. Hosaka and H. Koga, “Primary Pontine Hemorrhage: Clinicopathological Correlations,” Stroke, Vol. 11, No. 1, 1980, pp. 84-90. doi:10.1161/01.STR.11.1.84 [6] B. Russell, S. S. Rengachary and D. Mcgregor, “Primary Pontine Hematoma Presenting as a Cerebellopontine Angle Mass,” Neurosurgery, Vol. 19, No. 1, 1986, pp. 129-133. doi:10.1227/00006123-198607000-00023 [7] C. S. Chung and H. Park, “Primary Pontine Hemorrhage: A New CT Classification,” Neurology, Vol. 42, No. 4, 1992, pp. 830-834. [8] J. R. Mangiardi and F. J. Epstein, “Brainstem Haematomas: Review of the Literature and Presentation of Five New Cases,” Journal of Neurology, Neurosurgery & Psychiatry, Vol. 51, No. 7, 1988, pp. 966-976. doi:10.1136/jnnp.51.7.966