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.

Partially thrombosed vertebral artery dissecting aneurysm presenting as delayed bulbar compression after lateral medullary infarction.

A 48-year-old man experienced lateral medullary infarction resulting from spontaneous vertebral artery (VA) dissection. Minimal fusiform dilatation was noted on basi-parallel anatomic scanning-magnetic resonance imaging; therefore, the patient was treated conservatively. Eight months later, he experienced deterioration of dysphagia and the onset of gait ataxia. Repeated imaging studies showed enlargement of the VA aneurysm with bulbar compression. Parent artery occlusion on the proximal side of the VA affected by the dissection relieved the patient's symptoms. Although the majority of dissected lesions stabilize within a few months, studies with longer observation periods and more frequent neuroimaging examinations are required.

Midbrain hemorrhage presenting with oculomotor nerve palsy: case report.

BACKGROUND: We report a case of isolated oculomotor nerve palsy caused by a midbrain hemorrhage. CASE DESCRIPTION: A 75-year-old man visited our hospital complaining of double vision and left eye ptosis without headache. Neuro-ophthalmic examination showed that his left and right pupils were 3.5 mm and 3 mm in diameter, respectively, that left downward eye movement was limited, and that convergence of the right eye was limited. Magnetic resonance imaging (MRI) demonstrated that there was a hematoma located in the anterior tegmentum of the left midbrain. Two weeks after admission and treatment, including conservative therapy, his double vision gradually disappeared. CONCLUSION: To date, 73 cases have been reported in the literature. Most cases of isolated oculomotor nerve palsy have been caused by diabetes mellitus, aneurysm, or infarction. However, focal midbrain hemorrhage incidentally produces third nerve palsy. MRI is extremely helpful in diagnosing a small hemorrhage of the midbrain in such cases.