Spontane Ponsblutungen

Primary Pontine Haemorrhages 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 / 100000/ year include hypertension, vascular malformations (a.v.-haemangioma, cavernous haemangioma, capillary teleangiectasies), antico agulative treatment and inflammatory vascular disease. Diffusely spreeding hypertensive haemorrhages are of apo. plectiform onset with fast developing coma, and show disturbance of vegetative funetion (disturbance of respira tion, cardiac dysrhythmias, hyperthermia, hypertension), miosis and other neuroophthalmologie symptoms, flaccid tetraparelysis and blood-stained cerebrospinal fluid; mor telity is high, reaching 50% after 24 hours and 90% after 3 weeks. Vascular malformations are the origin of circum scribed pontine haematomas with slowly progressing dis turbance of consciousness and brain stem symptoms with variable course exhibiting multiple remissions and reeur rences. In respeet of symptomatology and clinical course, slight lateral hypertensive pontine haemorrhages must be placed b8tween these two typical syndromes. Diegnosis of pontine haemorrhages is supported by x-ray computed tomography, but vascular malformations can be deteeted only by cerebraI angiography. Treatment of pa tients with pontine haemorrhages must be based on intensive care with regular control via CT. Increased intracranial pres sure and internal hydrocephalus caused by blockage of CSF