Pontine hemorrhage

Introduction Bridge cerebral hemorrhage accounts for about 10% of cerebral hemorrhage, mostly caused by rupture of the pons of the basilar artery. Clinical manifestations include sudden headache, vomiting, dizziness, diplopia, different axes of the eye, side palsy, cross sputum or hemiplegia, quadriplegia. When the amount of bleeding is small, the patient's consciousness can be expressed as some typical syndromes, such as foville syndrome, millard-gubler syndrome, atresia syndrome, etc., may be accompanied by high fever, sweating, stress ulcers, acute pulmonary edema, Acute myocardial ischemia and even myocardial infarction. When a large amount of hemorrhage occurs, the hematoma spreads to both sides of the pons and the covered part of the pons. The patient quickly enters a coma. The bilateral pupils are needle-like, side-viewing paralysis, quadriplegia, difficulty breathing, and have a brain-strength attack. They can also vomit brown stomach contents. There are midline symptoms such as central hyperthermia, often dying within 48 hours.

Cause

Primary cerebral hemorrhage accounts for about 2% to 10%, mainly due to rupture of the median artery near the branch of the basilar artery. Common causes are high blood pressure and arteriosclerosis. A small number of patients may be caused by vascular malformations, blood diseases or tumors in the pons. More common in middle-aged and elderly people, mostly induced by emotional excitement and exertion.

an examination

Related inspection

Brain CT examination

Clinical manifestations include sudden headache, vomiting, dizziness, diplopia, different axes of the eye, side palsy, cross sputum or hemiplegia, quadriplegia. When the amount of bleeding is small, the patient's consciousness can be expressed as some typical syndromes, such as foville syndrome, millard-gubler syndrome, atresia syndrome, etc., may be accompanied by high fever, sweating, stress ulcers, acute pulmonary edema, Acute myocardial ischemia and even myocardial infarction. When a large amount of hemorrhage occurs, the hematoma spreads to both sides of the pons and the covered part of the pons. The patient quickly enters a coma. The bilateral pupils are needle-like, side-viewing paralysis, quadriplegia, difficulty breathing, and have a brain-strength attack. They can also vomit brown stomach contents. There are midline symptoms such as central hyperthermia, often dying within 48 hours.

Differential diagnosis

Differential diagnosis of cerebral hemorrhage:

1. Bridge cerebral hemorrhage needs to be differentiated from other different cerebral hemorrhage symptoms.

(1) Internal capsule bleeding: is the most common bleeding site. Its typical clinical manifestations are contralateral "three-biased" (hemiplegic, partial sensory disturbance, hemianopia). The range of internal cystic hemorrhage is large, and the symptoms of nerve damage are heavier. However, if the bleeding is biased to the outside of the internal capsule and mainly damages the outer capsule, the clinical symptoms are more mild, more unconscious, and the hemiplegia is lighter, and the prognosis is better.

(2) Thalamic hemorrhage: If there is a side of the thalamic hemorrhage, and the amount of bleeding is small, the contralateral side is paralyzed, and the contralateral sensory disturbance, especially the proprioceptive disorder. If the amount of bleeding is large, the damaged part affects the contralateral thalamus and the hypothalamus, then there is vomiting coffee-like substance, vomiting is frequent spray, and there are polyuria, urine sugar, quadriplegia, eyes to the nose and other symptoms. The condition is often critical and the prognosis is not good.

(3) cerebral hemorrhage: also known as subcortical white matter hemorrhage, can occur in any brain lobe. In addition to headache, vomiting, bleeding in different brain lobe, clinical manifestations are also different. Such as frontal lobe hemorrhage can appear psychiatric symptoms, such as irritability, doubt, contralateral hemiplegia, sports aphasia, etc.; parietal lobe hemorrhage appears contralateral sensory disturbance; temporal lobe hemorrhage can appear sensory aphasia, mental symptoms, etc; occipital lobe hemorrhage It is most common to use hemianopia. The general symptoms of cerebral hemorrhage are slightly milder and the prognosis is relatively good.

(4) ventricular hemorrhage: generally divided into primary and secondary, primary ventricular hemorrhage is intraventricular choroid plexus rupture, relatively rare. Secondary is due to the large amount of intracerebral hemorrhage, piercing the brain parenchyma into the ventricles. Clinical manifestations are vomiting, excessive sweating, purple or pale skin. One to two hours after the onset, he falls into deep coma, high fever, quadriplegia or tonic convulsions, unstable blood pressure, and irregular breathing. The condition is mostly serious and the prognosis is poor.

(5) cerebellar hemorrhage: if the amount of bleeding is small, the clinical manifestations are often first dizziness, followed by severe headache, frequent vomiting, unstable walking, unclear speech; if the amount of bleeding is large, oppress the medullary life center, severely can suddenly death.

2, people with conscious disabilities should be identified with systemic diseases that can cause coma. Patients with signs of nervous system localization should be differentiated from other intracranial lesions, meningoencephalitis, and closed brain trauma. It should also be differentiated from cerebrovascular diseases such as cerebral infarction and subarachnoid hemorrhage.

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