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Pontine Haemorrhage


Learning objectives

  • Learning
  • Understand
  • Integrate
  • Reflect

One older study from 1985 suggested that bleeds on CT < 2 cm did better

Introduction
  • Bleeding into the pons is associated with a high fatality up to 50%.
  • More benign forms can arise especially when hemipontine
Causes
  • Hypertension
  • Anticoagulants
  • AVM or Cavernoma
  • Malignancy
Clinical
  • Comatose depending on the extent of brainstem damage
  • Diplopia, nystagmus, nausea, vomiting
  • Quadriplegia, decerebration, bilateral miosis
  • Horizontal gaze palsy, locked in
  • Headache, ataxia, past pointing, nystagmus to affected side
  • Rare case studies of Bell's palsy type picture
Investigations
  • FBC, U&E, ECG, Coagulation screen, CXR
  • Non-contrast CT initially which should be sensitive enough to pick up posterior fossa blood
  • MRI/MRA maybe useful

Management
  • ABC, Intubation and ITU may be needed
  • Management is traditionally conservative. Outcome is hard to predict, some patients do very well and others less so.
  • In a younger patient it may be reasonable to intubate and ventilate and see what happens.
  • The fact that the fourth ventricle lies behind the pons means that any swelling here or bleeding into the ventricle can result in obstructive hydrocephalus which may require shunting.