Successful Evacuation of a Pontine Hematoma in Chronic Stage

Abstract

A 52-year-old male was brought to Wakakusa Daiichi Hospital by ambulance because he had fallen unconscious. On admission he was stuporous. Neurological examination revealed left-sided facial palsy, left-sided ptosis, right-sided hemiplegia, and marked impairment of horizontal eye movement except for convergence. Computed tomography (CT) revealed a small high density area in the paramedian tegmentum. Cerebral angiography showed no abnormal vessels. Three hours after admission he became alert. One month after admission the right-sided hemiplegia improved, but he could not walk by himself. CT performed 45 days after admission showed a low density area in the pontine tegmentum with the fourth ventricle compressed persistently. Fifty days after admission, suboccipital craniectomy and evacuation of the hematoma was performed. The postoperative course was uneventful. One week after surgery the bulbar palsy improved and the tracheotomy could be closed. One month later, facial palsy and hemiplegia had so improved that he could close his eyes and walk without aids. Half a year after evacuation of the hematoma, the patient recovered to partially assisted daily life. Cases of primary pontine hemorrhage successfully evacuated have been reported, but the majority of primary pontine hemorrhages are treated conservatively. The importance of evacuation of primary pontine hemorrhage in the chronic stage was recognized.