Primary brain stem haematomas. Diagnosis and treatment

Abstract

Case histories are reported of 18 patients in whom the diagnosis of primary brain stem haematoma and brain stem haemorrhage was made by computed tomography (CT). The possibility of an early diagnosis of brain stem haematoma, and the differential diagnosis of brain stem haemorrhage by a combination of clinical and tomodensitometric criteria is emphasized. It is concluded that CT is a highly reliable method for the diagnosis, location, and management of brain stem haematoma.

Primary brain stem haemorrhages: clinicoradiological considerations on five cases observed

“…Surgical removal of rhe blood is requir ed only if such co mplications occur (3,4,10,15). The clinical signs suggesting surgical therapy are impairmenr of consciousness, due to involvement of the reticular form ation, and respiratory distur banees.…”

“…With regard to the site of the lesion, which can then exrend upward and downward, the pons in its tegmenral-dorsal parr is the most commonly affected, followed, in o rder of frequener, by the mesencephalon always in its do rsal area . Primary bulbar haemo rrhages are quite rar e (2,6,8,9,15). Th e ventral region of the brain stern is usually spared.…”

“…From a surgical point of view we can make for the brain stern rhe same distincrion that is made berween haemorrhage and haematoma in the cerebral hemispheres: the haemor rhage, invading and disrup ting, and rhe haematcm a, a well-circumscribed lesion, usually not large, but one which can cause compression and obstructive hydrocephalus (15 ). Surgical removal of rhe blood is requir ed only if such co mplications occur (3,4,10,15).…”

Perioperative use of bispectral (BIS) monitor for a pressure ulcer patient with locked‐in syndrome (LIS)

“…The most common cause of LIS is basilar artery thrombosis causing ventral pontine infarction . Other pathologies include pontine haemorrhage and central pontine myelinolysis.…”

“…Other pathologies include pontine haemorrhage and central pontine myelinolysis. Bilateral ventral midbrain and internal capsule infarcts can present a similar diagnosis . The condition leaves the patient with intact sensation, but no motor control, which increases the risk for all complications of immobility including pressure ulcers.…”