Benign brainstem hemorrhage: A brief review

Abstract

Brainstem hemorrhage is usually associated with a poor prognosis. With the availability of cranial computed tomography (CT) in recent years, it has become apparent that some patients with hemorrhage in the brainstem may have milder symptoms and a better outcome. Although most such hemorrhages have been reported in the midbrain, benign hemorrhages have also been reported in the pons and medulla. This review summarizes reports in the literature with respect to the clinical features, diagnosis, and prognosis in patients with brainstem hemorrhage and a benign prognosis. My experience and review of the literature suggest that these hemorrhages are often missed until after cranial CT is performed, and etiology remains unknown in most cases. In patients with an arteriovenous malformation (AVM), angiographically visible or occult recurrences are frequent. In cases in which an etiology is not found, recovery is rapid and often complete or nearly complete, and recurrences are very rare.