Three-year prognosis of first-ever primary pontine hemorrhage in a hospital-based registry.

Our aim was to evaluate the mortality rate of primary pontine hemorrhage (PPH) and to determine the factors related to the prognosis. Limited data exist on the long-term prognosis and determinants of death in patients with PPH in China. Our study analyzed consecutive cases of first-ever PPH from April 2007 to March 2011 in a hospital-based stroke registry. Mortality rates during 30 day and 3 year follow-ups were analyzed. We used the Kaplan-Meier method to estimate the event rates and binary logistic regression analysis, and Cox proportional hazard regression analysis to identify predictors of short-term and long-term prognosis, respectively. A total of 76 patients were identified, 44 (57.89%) were men. Both 30 day and 3 year overall mortalities in men were higher than women but this different was not statistically significant. Coma on admission, hematoma ⩾ 4 mL and a massive hemorrhage were significantly related to 30 day mortality of PPH. Multivariate Cox proportional hazard regression revealed that coma on admission (hazard ratio [HR] 2.18; 95% confidence interval [CI] 1.16-4.13; p = 0.02) and hematoma ⩾ 4 mL (HR 2.23; 95% CI 1.25-3.96; p = 0.01) were independent predictors of 3 year mortality. In conclusion, the short-term mortality rate and factors related to the prognosis of Chinese patients with PPH are similar to those reported for other populations. A low Glasgow coma scale score on admission and a large hematoma volume may be related to poor 3 year prognosis after PPH.

Hemorragias cerebrales pontinas: estudio de 14 pacientes / Clinical study of 14 patients with pontine hemorrhage

Fundamento y objetivo: El propósito del presente estudio ha sido analizar las características clínicas y pronósticas de las hemorragias pontinas (HP) y compararlas con las hemorragias cerebrales subcorticales. Pacientes y método: Se ha realizado un estudio descriptivo de 14 pacientes con HP incluidos en el registo de ictus del Hospital del Sagrat Cor de Barcelona durante un período de 19 años. Se efectuó una comparación con 133 hemorragias cerebrales subcorticales. Resultados: Las HP se observaron en 14 pacientes, y representaron el 0,36% del total de ictus (n = 3.808) y el 3,4% de las hemorragias intracerebrales (n = 407). La hipertensión arterial fue el principal factor de riesgo (78,6%), seguida de la diabetes mellitus (21,4%) y la dislipemia (21,4%). Dos pacientes (14,3%) presentaron un síndrome lacunar en forma de hemiparesia motora pura. La mortalidad hospitalaria fue del 50%. El perfil clínico significativamente asociado con los HP fueron los síntomas vertiginosos (odds ratio = 27,38; intervalo de confianza del 95%, 2,43-218,7) y la afectación de los pares craneales (odds ratio = 26,28; intervalo de confianza del 95%, 5,84-118,17). Conclusiones: Las hemorragias cerebrales pontinas son poco habituales, presentan una elevada mortalidad hospitalaria y tienen un perfil clínico claramente diferenciado de las hemorragias cerebrales clásicas de topografía subcortical

Background and objective: To characterize the clinical features, etiology and prognosis of pontine hemorrhages (PH). Patients and method: Descriptive study of 14 patients with PH included in the Sagrat Cor Hospital of Barcelona Stroke Registry over a 19-year period. The vascular risk factors and clinical profiles in PH and subcortical hemorrhage group (n = 133) were compared. Results: PH accounted for 0.36% of all acute strokes (n = 3,808) and 3.4% of all intracerebral hemorrhages. Hypertension was present in 78.6%, diabetes mellitus in 21.4% and hyperlipidemia in 21.4%. Pure motor hemiparesis was present in 2 patients (14.3%). The overall in-hospital mortality rate was 50%. Dizziness (odds ratio = 27.38; 95% confidence interval, 2.43-218.7) and cranial nerve palsy (odds ratio = 26.28; 95% confidence interval, 5.84-118.17) were independent predictors related to PH. Conclusions: Hemorrhagic pontine stroke is infrequent, presents a high in-hospital mortality and clinical profiles were identified in PH versus subcortical hemorrhages