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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1988 Jul;51(7):966–976. doi: 10.1136/jnnp.51.7.966

Brainstem haematomas: review of the literature and presentation of five new cases.

J R Mangiardi 1, F J Epstein 1
PMCID: PMC1033202  PMID: 3060565

Abstract

Fifty-one cases of brainstem haematoma that have undergone neurosurgical intervention since Finkelnburg's first exploration in 1905, are presented, together with five new cases. The location, incidence, aetiological and pathological factors, as well as clinical syndromes are reviewed. Diagnostic criteria are presented. The distinction between brainstem "haematoma" and "haemorrhage" is stressed. A retrospective comparison of 56 surgically treated cases and 31 conservatively managed cases is made, as is an analysis of the natural history of the disease process. Based on currently available data, the conclusion is drawn that patients with brainstem haematomas fare quite well after surgical therapy.

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Selected References

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  1. Abroms I. F., Yessayan L., Shillito J., Barlow C. F. Spontaneous intracerebral haemorrhage in patients suspected of multiple sclerosis. J Neurol Neurosurg Psychiatry. 1971 Apr;34(2):157–162. doi: 10.1136/jnnp.34.2.157. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Albright A. L., Byrd R. P., Harrison M. L. Angiographically cryptic AVM presenting as a pontine tumor. Case report. J Neurosurg. 1980 Dec;53(6):846–848. doi: 10.3171/jns.1980.53.6.0846. [DOI] [PubMed] [Google Scholar]
  3. Arseni C., Staneiu M. Primary haematomas of the brain stem. Acta Neurochir (Wien) 1973;28(4):323–330. doi: 10.1007/BF01405650. [DOI] [PubMed] [Google Scholar]
  4. Beatty R. M., Zervas N. T. Stereotactic aspiration of a brain stem hematoma. Neurosurgery. 1983 Aug;13(2):204–207. doi: 10.1227/00006123-198308000-00019. [DOI] [PubMed] [Google Scholar]
  5. Becker D. H., Silverberg G. D. Successful evacuation of an acute pontine hematoma. Surg Neurol. 1978 Oct;10(4):263–265. [PubMed] [Google Scholar]
  6. Bosch D. A., Beute G. N. Successful stereotaxic evacuation of an acute pontomedullary hematoma. Case report. J Neurosurg. 1985 Jan;62(1):153–156. doi: 10.3171/jns.1985.62.1.0153. [DOI] [PubMed] [Google Scholar]
  7. Burns J., Lisak R., Schut L., Silberberg D. Recovery following brainstem hemorrhage. Ann Neurol. 1980 Feb;7(2):183–184. doi: 10.1002/ana.410070215. [DOI] [PubMed] [Google Scholar]
  8. COURVILLE C. B. Obstructive internal hydrocephalus incident to small vascular anomaly of midbrain. Report of case. Bull Los Angel Neuro Soc. 1961 Mar;26:41–45. [PubMed] [Google Scholar]
  9. CURRIER R. D., GILES C. L., DEJONG R. N. Some comments on Wallenberg's lateral medullary syndrome. Neurology. 1961 Sep;11:778–791. doi: 10.1212/wnl.11.9.778. [DOI] [PubMed] [Google Scholar]
  10. Caplan L. R., Goodwin J. A. Lateral tegmental brainstem hemorrhages. Neurology. 1982 Mar;32(3):252–260. doi: 10.1212/wnl.32.3.252. [DOI] [PubMed] [Google Scholar]
  11. Cioffi F. A., Tomasello F., D'Avanzo R. Pontine hematomas. Surg Neurol. 1981 Jul;16(1):13–16. doi: 10.1016/s0090-3019(81)80051-1. [DOI] [PubMed] [Google Scholar]
  12. Coffey R. J., Lunsford L. D. Stereotactic surgery for mass lesions of the midbrain and pons. Neurosurgery. 1985 Jul;17(1):12–18. doi: 10.1227/00006123-198507000-00003. [DOI] [PubMed] [Google Scholar]
  13. Cole F. M., Yates P. O. The occurrence and significance of intracerebral micro-aneurysms. J Pathol Bacteriol. 1967 Apr;93(2):393–411. doi: 10.1002/path.1700930202. [DOI] [PubMed] [Google Scholar]
  14. DINSDALE H. B. SPONTANEOUS HEMORRHAGE IN THE POSTERIOR FOSSA.A STUDY OF PRIMARY CEREBELLAR AND PONTINE HEMORRHAGES WITH OBSERVATIONS ON THEIR PATHOGENESIS. Arch Neurol. 1964 Feb;10:200–217. doi: 10.1001/archneur.1964.00460140086011. [DOI] [PubMed] [Google Scholar]
  15. Dhopesh V. P., Greenberg J. O., Cohen M. M. Computed tomography in brainstem hemorrhage. J Comput Assist Tomogr. 1980 Oct;4(5):603–607. doi: 10.1097/00004728-198010000-00005. [DOI] [PubMed] [Google Scholar]
  16. Doczi T., Thomas D. G. Successful removal of an intrapontine haematoma. J Neurol Neurosurg Psychiatry. 1979 Nov;42(11):1058–1061. doi: 10.1136/jnnp.42.11.1058. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. EPSTEIN A. Primary massive pontine hemorrhage; a clinico-pathological study. J Neuropathol Clin Neurol. 1951 Oct;10(4):426–448. doi: 10.1097/00005072-195110000-00008. [DOI] [PubMed] [Google Scholar]
  18. GROTTS B. F. Spontaneous hemorrhage from a hemangioma of the pons. J Pediatr. 1950 Jul;37(1):98–101. doi: 10.1016/s0022-3476(50)80010-0. [DOI] [PubMed] [Google Scholar]
  19. Gonzalez A. C., Gallego J. H., Sanchez A. P. Brain-stem hematomas. J Neurosurg. 1983 Mar;58(3):456–457. doi: 10.3171/jns.1983.58.3.0456a. [DOI] [PubMed] [Google Scholar]
  20. Goto N., Kaneko M., Hosaka Y., Koga H. Primary pontine hemorrhage: clinicopathological correlations. Stroke. 1980 Jan-Feb;11(1):84–90. doi: 10.1161/01.str.11.1.84. [DOI] [PubMed] [Google Scholar]
  21. Humphreys R. P. Computerized tomographic definition of mesencephalic hematoma with evacuation through pedunculotomy. Case report. J Neurosurg. 1978 Nov;49(5):749–752. doi: 10.3171/jns.1978.49.5.0749. [DOI] [PubMed] [Google Scholar]
  22. KEMPE L. G. SURGICAL REMOVAL OF AN INTRAMEDULLARY HAEMATOMA SIMULATING WALLENBERG'S SYNDROME. J Neurol Neurosurg Psychiatry. 1964 Feb;27:78–80. doi: 10.1136/jnnp.27.1.78. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Kase C. S., Maulsby G. O., Mohr J. P. Partial pontine hematomas. Neurology. 1980 Jun;30(6):652–655. doi: 10.1212/wnl.30.6.652. [DOI] [PubMed] [Google Scholar]
  24. Koos W. T., Sunder-Plassmann M., Salah S. Successful removal of a large intrapontine hematoma. Case report. J Neurosurg. 1969 Dec;31(6):690–694. doi: 10.3171/jns.1969.31.6.0690. [DOI] [PubMed] [Google Scholar]
  25. Kowada M., Yamaguchi K., Ito Z., Matsuoka S. Pneumoencephalo-roulette tomography of operated primary pontine haemorrhage with long survival: report of two cases. J Neurol Neurosurg Psychiatry. 1972 Apr;35(2):243–246. doi: 10.1136/jnnp.35.2.243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. La Torre E., Delitala A., Sorano V. Hematoma of the quadrigeminal plate. Case report. J Neurosurg. 1978 Oct;49(4):610–613. doi: 10.3171/jns.1978.49.4.0610. [DOI] [PubMed] [Google Scholar]
  27. Lassiter K. R., Alexander E., Jr, Davis C. H., Jr, Kelly D. L., Jr Surgical treatment of brain stem gliomas. J Neurosurg. 1971 Jun;34(6):719–725. doi: 10.3171/jns.1971.34.6.0719. [DOI] [PubMed] [Google Scholar]
  28. MARGOLIS G., ODOM G. L., WOODHALL B. Further experiences with small vascular malformations as a cause of massive intracerebral bleeding. J Neuropathol Exp Neurol. 1961 Jan;20:161–167. doi: 10.1097/00005072-196101000-00011. [DOI] [PubMed] [Google Scholar]
  29. MYERS J., SCOTT M., SILVERSTIN A. Cystic hemangioblastoma of pons. J Neurosurg. 1961 Sep;18:694–697. doi: 10.3171/jns.1961.18.5.0694. [DOI] [PubMed] [Google Scholar]
  30. Mattos Pimenta L. H., Mattos Pimenta A., Zuckerman E. Pontine haematoma: successful removal of two cases with review of 22 cases previously described in accessible literature. Neurosurg Rev. 1981;4(3):139–142. doi: 10.1007/BF01743639. [DOI] [PubMed] [Google Scholar]
  31. McCormick W. F., Nofzinger J. D. "Cryptic" vascular malformations of the central nervous system. J Neurosurg. 1966 May;24(5):865–875. doi: 10.3171/jns.1966.24.5.0865. [DOI] [PubMed] [Google Scholar]
  32. McMENEMEY W. H. The significance of subarachnoid bleeding. Proc R Soc Med. 1954 Aug;47(8):701–704. [PubMed] [Google Scholar]
  33. Murphy M. G. Successful evacuation of acute pontine hematoma. Case report. J Neurosurg. 1972 Aug;37(2):224–225. doi: 10.3171/jns.1972.37.2.0224. [DOI] [PubMed] [Google Scholar]
  34. Müller H. R., Wüthrich R., Wiggli U., Hünig R., Elke M. The contribution of computerized axial tomography to the diagnosis of cerebellar and pontine hematomas. Stroke. 1975 Sep-Oct;6(5):467–475. doi: 10.1161/01.str.6.5.467. [DOI] [PubMed] [Google Scholar]
  35. Naito M., Kitaoka T., Tomihara K., Uozumi T. [A case of surgically cured atypical intrapontine hematoma (author's transl)]. No Shinkei Geka. 1980 Feb;8(2):199–203. [PubMed] [Google Scholar]
  36. O'Laoire S. A., Crockard H. A., Thomas D. G., Gordon D. S. A report of six surgically treated cases. J Neurosurg. 1982 Feb;56(2):222–227. doi: 10.3171/jns.1982.56.2.0222. [DOI] [PubMed] [Google Scholar]
  37. Obrador S., Dierssen G., Odoriz B. J. Surgical evacuation of a pontine-medullary hematoma. Case report. J Neurosurg. 1970 Jul;33(1):82–84. doi: 10.3171/jns.1970.33.1.0082. [DOI] [PubMed] [Google Scholar]
  38. PAILLAS J. E., LESBROS A., BONNAL J., LAVIEILLE J., JALFRE M. SYNDROME ALTERN'E PAR H'EMATOME DE LA PROTUB'ERANCE. OP'ERATION. Rev Otoneuroophtalmol. 1963 Mar-Apr;35:100–101. [PubMed] [Google Scholar]
  39. Pak H., Patel S. C., Malik G. M., Ausman J. I. Successful evacuation of a pontine hematoma secondary to rupture of a venous angioma. Surg Neurol. 1981 Mar;15(3):164–167. doi: 10.1016/0090-3019(81)90130-0. [DOI] [PubMed] [Google Scholar]
  40. Papo I., Pasquini U., Salvolini U. Subependymal brainstem hematomas: a report of two cases. Neuroradiology. 1976 Sep 21;11(5):279–282. doi: 10.1007/BF00328386. [DOI] [PubMed] [Google Scholar]
  41. Pau A., Sehrbundt Viale E., Turtas S. Surgical removal of a pontine haematoma associated with a cryptic angioma. Case report. Acta Neurochir (Wien) 1979;50(3-4):299–303. doi: 10.1007/BF01808528. [DOI] [PubMed] [Google Scholar]
  42. Payne H. A., Maravilla K. R., Levinstone A., Heuter J., Tindall R. S. Recovery from primary pontine hemorrhage. Ann Neurol. 1978 Dec;4(6):557–558. doi: 10.1002/ana.410040615. [DOI] [PubMed] [Google Scholar]
  43. Pouyanne M. H., Got M., Julien J., Riemens V., Paoli M. Deux cas d'hématomes intraprotubérantiels opérés. Etude critique. Neurochirurgie. 1967 Nov;13(6):738–742. [PubMed] [Google Scholar]
  44. SCOTT M., SILVERSTEIN A. Intrapontine cyst verified by surgical drainge into the fourth ventricle. Report of a case with an unusual neurological syndrome. J Neurosurg. 1960 May;17:520–528. doi: 10.3171/jns.1960.17.3.0520. [DOI] [PubMed] [Google Scholar]
  45. Sako K., Moriwaka F., Kishihara T., Nakagawa Y., Tashiro K., Abe H. [Primary pontine hemorrhage in children -- report of a case (author's transl)]. No Shinkei Geka. 1979 Apr;7(4):383–387. [PubMed] [Google Scholar]
  46. Scott B. B., Seeger J. F., Schneider R. C. Successful evacuation of a pontine hematoma secondary to rupture of a pathologically diagnosed "cryptic" vascular malformation. Case report. J Neurosurg. 1973 Jul;39(1):104–108. doi: 10.3171/jns.1973.39.1.0104. [DOI] [PubMed] [Google Scholar]
  47. Sundaresan N., Galicich J., Krol G., Rosen G. Successful surgical treatment of pontine vascular malformation in a 3-year old. Case report. Childs Brain. 1979;5(2):131–136. doi: 10.1159/000119811. [DOI] [PubMed] [Google Scholar]
  48. TEILMANN K. Hemangiomas of the pons. AMA Arch Neurol Psychiatry. 1953 Feb;69(2):208–223. doi: 10.1001/archneurpsyc.1953.02320260066005. [DOI] [PubMed] [Google Scholar]
  49. TENUTO R. A., CRUZ O. R. Hematoma intraprotuberancial. Arq Neuropsiquiatr. 1958 Sep;16(3):201–204. doi: 10.1590/s0004-282x1958000300002. [DOI] [PubMed] [Google Scholar]
  50. Vaquero J., Areitio E., Leunda G., Bravo G. Hematomas of the pons. Surg Neurol. 1980 Aug;14(2):115–118. [PubMed] [Google Scholar]
  51. Wong S. K., Duffy G. P. Surgical treatment of spontaneous pontine haematoma. J R Soc Med. 1982 Mar;75(3):206–209. doi: 10.1177/014107688207500311. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Zeller R. S., Chutorian A. M. Vascular malformations of the pons in children. Neurology. 1975 Aug;25(8):776–780. doi: 10.1212/wnl.25.8.776. [DOI] [PubMed] [Google Scholar]
  53. Zuccarello M., Iavicoli R., Pardatscher K., Scanarini M., Fiore D., Andrioli G. C. Primary brain stem haematomas. Diagnosis and treatment. Acta Neurochir (Wien) 1980;54(1-2):45–52. doi: 10.1007/BF01401942. [DOI] [PubMed] [Google Scholar]

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