Primary Pontine Hemorrhage. An Analysis of 35 Cases and Research in Prognostic Factors / 대한뇌혈관외과학회지

ABSTRACT

OBJECTIVE: Primary pontine hemorrhage (PPH) accounts approximately for about 5~10% of intracranial hemorrhages, and overall mortality rate in recent studies is 40~50%. In a general way, primary treatment of PPH is conservative. Although some authors are trying to surgical treatment for PPH recently, treatment guideline still remains controversy. We report our study to establish the clinical and radiologic prognostic factors in PPH patients and present the guideline for surgical treatment. METHODS: We analyzed 35 patients with PPH admitted to our hospital between January 2000 and December 2006. Glasgow Coma Scale (GCS) scores were assessed on admission, and Glasgow Outcome Scale (GOS) scores on discharge. We divided the patients into two groups according to GOS score: (1) patients who had bad prognosis, and (2) patients who had good one. The two groups were compared for age, gender, hypertension, initial GCS, pupillary abnormalities, volume and location of hemorrhage, intraventricular and extrapontine extension, need for mechanical ventilation and hydrocephalus. RESULTS: Twenty-one patients (60%) were hypertensive. Twenty patients (57%) survived and six of them were capable of performing activities of daily living within 3 months of the hemorrhage. Significant prognostic factors were found with coma on admission, GCS score on admission, hematoma location, hematoma volume, need for mechanical ventilation and intraventricular hemorrhage. CONCLUSION: Initial GCS score, size and location of the hematoma, coma on admission, need for mechanical ventilation and intraventricular extension were significantly correlated to poor outcome in our study. If more large studies follow up including surgical outcome, we could make a surgical indication for PPH to improve the mortality and prognosis.