Subependymal brainstem hematomas: A report of two cases

Papo, I; Pasquini, U.; Salvolini, U.

doi:10.1007/bf00328386

Cited by 28 publications

(5 citation statements)

References 12 publications

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“…This fact is emphasized by many authors (8,13) that one has to distinguish this group of patients from those that are affected by brainstem haemorhage of arteriosclerotic aetiology. In the literature 42% of cases are persons under the age of 25 years.…”

Section: Discussionmentioning

confidence: 99%

“…A review of the history and neurological picture of the cases published in literature shows: 1) Dandy, (1932) was reported to be the first to operate a case of pontine haematoma with good result (13). A review of the history and neurological picture of the cases published in literature shows: 1) Dandy, (1932) was reported to be the first to operate a case of pontine haematoma with good result (13).…”

Section: Discussionmentioning

confidence: 99%

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Pontine haematoma: Successful removal of two cases with review of 22 cases previously described in accessible literature

Pimenta¹,

Pimenta²,

Zuckerman³

1981

Neurosurg. Rev.

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Two cases of operative evacuation of pontine haematomas are described in addition to 22 cases reported in the literature. Clinical and neuroradiological findings indicate a brain stem lesion sometimes considered as an inoperable brain stem glioma. Computer assisted tomography todate easily reveals such hematomas. Successful operative results are generally obtained. This diagnosis must be considered when the onset of symptoms is progressive and young people are affected. We describe two young patients with rapidly progressive symptoms. In one case (case 2) the symptoms started after a bee sting but we were unable to find any real correlation. Surgical removal of blood clot was followed by progressive improvement in the patients who were able to return to normal active life.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pontine haematoma: Successful removal of two cases with review of 22 cases previously described in accessible literature

Pimenta¹,

Pimenta²,

Zuckerman³

1981

Neurosurg. Rev.

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“…Intra-axial haematomas are not distinguishable from intrinsic brainstem expanding tumours, which are generally not considered suitable for surgical therapy. Gros et al (1948), Scoville and Poppen (1949), Kempe (1964), Matson (1968), Dandy (1969), Obrador et al (1970) Abroms et al (1971) Kowada et al (1971 and Papo et al (1976) reported successful evacuation of subependymal brainstem haematomas. Myers et al (1961) Kowada et al (1971, and Scott et al (1973) reported successful evacuation of intraaxial brainstem haematoma.…”

Section: Discussionmentioning

confidence: 99%

Successful removal of an intrapontine haematoma.

Dóczi¹,

Thomas²

1979

Journal of Neurology, Neurosurgery & Psychiatry

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SUM MAR Y A patient with progressive signs and symptoms suggestive of a pontine lesion is described. Intracranial investigations, CAT scan, vertebral angiography, and lumbar pneumoencephalogram revealed a space-occupying lesion of the pons and midbrain. The exact nature of the lesion was not established before the operation. A posterior fossa exploration was performed and a pontine haematoma was discovered and evacuated. The pathological specimen was designated as a cryptic arteriovenous malformation. Preoperative neurological deficits disappeared except for minimal left sixth nerve palsy and mild truncal ataxia. Dandy (1969) was the first to report the evacuation of a haematoma of the brainstem. Since that time a few additional reports have been made but the surgical treatment of this condition is still an extreme rarity. Recently interest has been focused on the feasibility of a more aggressive surgical approach to brainstem glioma as patients with cystic brainstem tumours can be long-term survivors after aspiration and radiation therapy as reported by Lassiter et al. (1971) examination although there was occasional paraesthesia in the right limbs. She had very severe, mainly truncal, ataxia, and was not able to stand or walk. Intracranial investigation with a CAT scan revealed an extensive high attenuation area in the brainstem, involving predominantly the posterior part, crossing the midline, but more extensive on the left. The brainstem was swollen, compressing the fourth ventricle, and the high attenuation area extended from the lower pons into the midbrain with swelling of the left cerebral peduncle, encroaching on the interpeduncular cisterns. There was low CAT attenuation with some mass effect seen in the region of the left hypothalamus and temporal region. There was no change after contrast injection. There was no hydrocephalus (Fig. 1). A vertebral angiogram confirmed the presence of swelling on the left side of the pons with forward displacement of the basilar artery and slight backward displacement of the choroidal point. No pathological vessels were seen. A lumbar pneumoencephalogram confirmed that there was an intrinsic swelling of the brainstem, pons, and midbrain extending up to the cerebral peduncle on the left side (Fig. 2a, b). The density of the lesion shown on the CAT scan was compatible with a haematoma but the other 1058

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“…Bei vielen benignen Hirnstammhämatomen mit langwierigem Verlauf (9), die wegen ihrer scharfen Begrenzung definierte pontine Syndrome bilden und deshalb exakt lokalisierbar sind (2, 72), werden -wie bei unserem 10. Fallim histologischen Präparat keine Gefäßanomalien gefunden, weil diese durch die Blutung zerstört wurden (1,6,25,48,55,60,63,78,89,94,97,99,101,120).…”

Section: Hypertone Blutungenunclassified

Spontane Ponsblutungen

Bewermeyer¹,

Neveling²,

Ebhardt³

et al. 1984

Fortschr Neurol Psychiatr

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Data from 11 observed patients with spontaneous pontine haemorrhages were compared to the findings in 235 cases reported in 9 studies. Causes of pontine haemorrhages which have an incidence of 2 to 4/100 000/year include hypertension, vascular malformations (a.v.-haemangioma, cavernous haemangioma, capillary teleangiectasies), anticoagulative treatment and inflammatory vascular disease. Diffusely spreading hypertensive haemorrhages are of apo-plectiform onset with fast developing coma, and show disturbance of vegetative function (disturbance of respiration, cardiac dysrhythmias, hyperthermia, hypertension), miosis and other neuroophthalmologic symptoms, flaccid tetraparalysis and blood-stained cerebrospinal fluid; mortality is high, reaching 50% after 24 hours and 90% after 3 weeks. Vascular malformations are the origin of circumscribed pontine haematomas with slowly progressing disturbance of consciousness and brain stem symptoms with variable course exhibiting multiple remissions and recurrences. In respect of symptomatology and clinical course, slight lateral hypertensive pontine haemorrhages must be placed between these two typical syndromes. Diagnosis of pontine haemorrhages is supported by x-ray computed tomography, but vascular malformations can be detected only by cerebral angiography. Treatment of patients with pontine haemorrhages must be based on intensive care with regular control via CT. Increased intracranial pressure and internal hydrocephalus caused by blockage of CSF passage necessitate ventricular drainage. While hypertensive pontine haemorrhages cannot be surgically treated, pontine haematomas and the causative vascular malformations can be removed.

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Subependymal brainstem hematomas: A report of two cases

Cited by 28 publications

References 12 publications

Pontine haematoma: Successful removal of two cases with review of 22 cases previously described in accessible literature

Pontine haematoma: Successful removal of two cases with review of 22 cases previously described in accessible literature

Successful removal of an intrapontine haematoma.

Spontane Ponsblutungen

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