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Internal Medicine

Pontine haemorrhage (PH)

Form of intracranial hemorrhage (ICH).

Form of intracranial hemorrhage (ICH).

  • 10% of intracerebral haemorrhages (ICH)

Epidemiology

  • Mortality rate: 30-90% | PH is the most pernicious form of ICH
  • Predictors of mortality:
    • Level of consciousness on admission
    • Haemorrhage size
jkms-26-100-g001
Cumulative mortality curve. The one-year mortality rate was 64.8% and 2-yr mortality rate 72.3%. | Jang, J. H., Song, Y. G., & Kim, Y. Z. (2011). Predictors of 30-day mortality and 90-day functional recovery after primary pontine haemorrhage. Journal of Korean medical science, 26(1), 100–107. https://doi.org/10.3346/jkms.2011.26.1.100

Classification

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Computed tomography classification of pontine haemorrhage localisations | From top left, clockwise: massive, basal tegmental, bilateral tegmental and unilateral tegmental. | Chung CS andPark CH. Primary pontine hemorrhage: a new CT classification. Neurology 1992; 42: 830–834.

Aetiology

  • Long-standing poorly-controlled chronic hypertension

Clinical features

  • Deep coma
  • Quadriparesis and multiple cranial nerve dysfunction
  • Decerebrate rigidity
  • Pinpoint pupils
  • Hyperpnea, hyperpyrexia, severe hypertension, and hyperhidrosis

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