Pontine hemorrhage

Case contributed by Dr Amit Chacko


Unheralded syncope while eating hot chilli.

Patient Data

Age: 35 years
Gender: Male

A large hematoma is present in the pons, measuring 23 mm in diameter. The pons and medulla are edematous and enlarged. The cerebellar hemispheres are preserved. No surface collection evident, and no intraventricular or subarachnoid hemorrhage evident. No supratenorial abnormality. The vertebral arteries are patent with no evidence of dissection nor aneurysm and no abnormal vascular channels evident. The internal carotid and cerebral arteries likewise are normal in appearance.

Case Discussion

In intensive care the patient was unresponsive with no observable cranial nerve function. Corneal and gag reflexes were also absent on examination. Due to the preservation of his cerebellar hemispheres he was presumed to have locked in syndrome. The cause of the hemorrhage was likely due to the patient's uncontrolled hypertension for which he was non-compliant with his medication.

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Case information

rID: 56772
Published: 21st Nov 2017
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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