Pontine Hemorrhages and Prognosis

ABSTRACT

Pontine hematomas are very rare lesions that in the past found at postmortem examination rather than diagnosed from the clinical presentations. Computed tomography has particularly stimulated further neurosurgical interest in this relatively rare condition, making surgical evacuation possible in some cases. Four patients suffering from pontine hemorrhages, revealed by computed tomography, are discussed. The classification regard to the site, clinical features and outcomes of this lesion are discussed in an attempt to establish general criteria for adequate management. With regard to the site, three types of hemorrhage are to be considered the tegmentotectal(type I), the tegmentolateral(type II) and the tegmentobasilar(type III), 2 patients(type I II, treated conservatively) had a fair outcome, and 2 patients(one of type III, treated conservatively, and one of type I, by surgical evacuation) had a death. Surgical management for the pontine hemorrhages should be reserved for the type I(tegmontotectal) and type II(tegmentolateral), whenever the neurological conditions deteriorate progressively.