Massive pontine hemorrhage with comatose condition has a poor prognosis and bad outcome
despite adequate surgical treatment. However, this case report gives a different result.
Providing adequate prophylactic treatment to prevent secondary brain injury resulted
in a very good recovery at the 6-month follow-up. A 42-year-old man with a history
of heavy smoking and poorly controlled blood pressure (BP) developed acute loss of
consciousness. He was then brought to the emergency room (ER) in 30 min. At the ER,
his Glasgow coma scale score was E1M2V1 and the BP was high. An emergency computed
tomography (CT) scan of the brain showed massive hematoma in the pons with intraventricular
extension. He was admitted to the intensive care unit with close monitoring of both
vital signs and neurosigns. External ventricular drainage was inserted to control
intracranial pressure and then removed in only 5 days after adequate control. The
patient returned to a good recovery status in 6 months with a modified Rankin scale
score of 2 and the CT brain scan showed a small cavity-like lesion at the hemorrhage
area. Massive hemorrhage and low consciousness may not truly indicate a poor prognosis
in patients with pontine hematoma. Medical and surgical treatments are still needed
to control intracranial pressure for prophylaxis of secondary brain injury. Restoration
of neuronal functions was achieved after resolution of the hematoma.
Key-words:
Good recovery - hypertensive hemorrhage - massive pontine hemorrhage - poor prognostic
factors
