高血圧性脳橋出血の臨床と病理:-意識下に長期生存した一手術施行例における検討-

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It is generally accepted that 90 per cent of primary pontine hematoma is of hypertensive nature and it consists of 10 per cent of all hypertensive intracerebral hematoma. For the past three years, we admitted 136 cases of hypertensive intracerebral hematoma which included 20 cases of pontine hematoma. Of those, 14 cases took a fulminant course and died within few hours or at least few days after the attack. The rest of 6 cases were operated and three cases returned to home life, one survived for ten months with consciousness and two cases died after operation. On this paper, we will review the clinical course and autopsy findings on the above case which was operated and survived for ten months with consciousness. Case report; 69 year-old man who had been hypertensive for the past 5 years, suddenly developed headache and vomitting while he was drinking alcohol. Soon he became semicomatous. He was admitted to our hospital one hour later, when blood pressure was 200/100mmHg with irregular respiration. Pupils were 1.5 mm in diameter bilaterally and fixed in the midline with preserved light reflex. No oculocephalic movement elicited. He showed left facial weakness and paralysis of the right extremity with right hemihypesthesia including face. Urgent carotid angiography and conray ventriculography revealed the elevation of the 4th ventricular floor in the level of the facial nucleus, suggesting the pontine hematoma. Subsequently, he was operated in the sitting position two hours after the attack. By suboccipital craniectomy, the 4th ventricular floor was exposed where there was a edematous swelling along the left facial colliculus with partial petechial hemorrhage on it. A small longitudinal incision was done in the side of the left facial colliculus and 3 or 4 cc of the clot was evacuated in the depth of about 5 or 7mm under the operating microscope. Immediately after the operation, his respiratory condition was improved and blood pressure returned to 160/90mmHg. On the 6th postoperative day he recovered consciousness and could respond to the simple order. In the second week, he could speak few words and pupils showed the'one and a half syndrome'. He could drink by mouth for some time but had the difficulty of the swallowing all the time. Having the bed-ridden life, finally he died 10 months later for the malnutrition. Autopsy findings; Coronal section of the pons revealed atrophic scar in the left tegmentum which was hemosiderin-depositted and partly microcystic. The hematoma seemed to be localized in the left pontine tegmentum and the extent in the longitudinal direction was from the upper end of the pons to the lower 1/3 of the pons. It seemed to us from the above findings that the operative evacuation of the hematoma could have been effective.
The Japanese Society on Surgery for Cerebral Strokeの論文

高血圧性脳橋出血の臨床と病理:-意識下に長期生存した一手術施行例における検討-

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